Correct!
5. All of the above

All were performed. Her blood cultures had no growth. Plasma NT-pro-BNP was markedly elevated at 17,685 pg/ml (normal < 300 under the age of 50). Her echocardiogram showed inferior septum regional hypokinesis with an ejection fraction of   45%. Her electrocardiogram is shown in Figure 2.

Figure 2. Admission electrocardiogram.

In addition, her troponin was elevated at 18.9 ng/mL (normal <0.1), C-reactive protein  299 mg/dL (normal <10) and creatine phosphokinase 760 U/L (normal <198). She was diagnosed with acute myocarditis and rapidly improved with supportive therapy.  

Which additional tests are indicated? (Click on the correct answer to proceed to the third of four panels)

  1. ELISA for IgM antibodies against Coxsackie virus
  2. ELISA for T. cruzi
  3. Peripheral blood smear
  4. Viral stool culture
  5. All of the above

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