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Connection between the heart and the gut
  1. Bostjan Berlot1,2,
  2. Iwan Harries2,3,
  3. Chiara Bucciarelli-Ducci2,3
  1. 1Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2Clinical Research and Imaging Centre, University of Bristol, Bristol, UK
  3. 3NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Bostjan Berlot, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK; bostjan.berlot{at}gmail.com

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Clinical introduction

A 45-year-old man with ulcerative colitis was admitted with bloody diarrhoea and chest pain. Inflammatory markers and high-sensitivity troponin were elevated (C reactive protein 57 mg/L, white cell count 10.65×109/L, neutrophil 6.6×109/L, Troponin-I 663 mmol/L). The ECG showed inferior ST-elevation. Urgent coronary angiography revealed unobstructed coronary arteries. Inpatient cardiovascular magnetic resonance (CMR) was arranged to determine the aetiology of the myocardial infarction with non-obstructive coronary arteries. The imaging protocol at 1.5 T included balanced steady-state free precession cine images, T2-weighted oedema sequences, and early and late gadolinium enhancement (LGE). Native T1 and T2 mapping images provided advanced tissue characterisation.

Question

What is the most likely diagnosis based on the MRI findings?

  1. Multiple embolic myocardial infarctions in the right coronary …

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