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Effects of exercise therapy on polymyositis complicated by post-myocarditis cardiomyopathy: A case report

H Yanagi, N Shindo
2017 Journal of Rehabilitation Medicine  
A 42-year-old woman was admitted on 30 May 2013, with a blood pressure of 180/100 mmHg. Multifocal ventricular extrasystoles were observed on 12-lead electrocardiography, with an enlarged cardiac silhouette on chest radiography, global hypokinesis on echocardiography, and a left ventricular ejection fraction of 40%, with left ventricular end-diastolic diameter 54 mm, left ventricular end-systolic diameter 43 mm, left atrial diameter 41 mm, and E/e' 9. Creatine kinase (CK) level was 2,559 IU/l;
more » ... el was 2,559 IU/l; CK-MB, 44 IU/l; lactate dehydrogenase (LDH), 478 IU/l; aspartate aminotransferase (AST), 67 IU/l; and alanine aminotransferase (ALT), 41 IU/l; with a positive troponin T result. No significant stenosis was observed on coronary angiography. Subsequently, myocarditis was diagnosed based on cardiac magnetic resonance imaging, myocardial perfusion scintigraphy, and endomyocardial biopsy. Because of proximal muscle weakness, elevated myogenic enzyme levels, and myogenic changes on electromyography, a muscle biopsy was also performed, leading to a diagnosis of polymyositis with accompanying myocarditis. Prednisolone was commenced at 45 mg/day, along with high-dose intravenous γ-globulin therapy, which resulted in a reduction in myogenic enzyme levels, but only a slight improvement in cardiomyopathy. Subsequent administration of β-blockers reduced the frequency of extrasystoles and protected cardiac function, and prednisolone dose was reduced to 35 mg/day on discharge. As prolonged hospital admission resulted in considerable muscle weakness and reduced exercise tolerance, rehabilitation was commenced. Upon rehabilitation commencement, the CK level was 201 IU/l; CK-MB, Background: A 42-year-old woman with chronic polymyositis complicated by post-myocarditis cardiomyopathy underwent supervised and unsupervised exercise therapy with staged increases in intensity. Methods: Supervised exercise therapy, which included adopted standards for patients with heart failure, was performed for 6 months. After one month, unsupervised exercise therapy was commenced, in the form of 15 min walking, the duration of which was increased to 30 min after 2 months. Results: Improvements in muscle strength, balance, gait velocity, and exercise tolerance were observed, with no exacerbation of myositis or heart failure. At 6 months, the level of physical activity reached that of an age-matched healthy person. Conclusion: With appropriate care to avoid exacerbation of heart failure and myositis, staged increases in the volume of supervised and unsupervised exercise therapy can safely and effectively maintain and improve physical capacity, exercise tolerance, and overall physical activity.
doi:10.2340/16501977-2206 pmid:28218333 fatcat:yszuje5xqja47gut5gdfellf64