806-1 Pattern of cardiac isoenzyme elevation in probable smallpox associated myocarditis

Chest Pain, ST Elevation, and Positive Cardiac Enzymes in an Austere Environment: Differentiating Smallpox Vaccination-mediated Myocarditis and Acute Coronary Syndrome in Operation Iraqi Freedom

“…Although the findings of cardiac enzyme elevation in the ED are suggestive of ACS, the serial pattern of cardiac enzymes demonstrates a different pattern to characteristic "rise and fall" serology (7,13,14). Whereas the peak creatine kinase in ACS may not be seen for 12 to 24 h, with myopericarditis, the presenting value tends to be the peak value (7,14).…”

“…Whereas the peak creatine kinase in ACS may not be seen for 12 to 24 h, with myopericarditis, the presenting value tends to be the peak value (7,14). Similarly, with ACS, the troponin may reach mean values nearly 20-fold higher than those at presentation within 48 h, whereas myopericarditis represents a "smoldering" myocardial injury with mean troponin values Ͻ 8-fold higher than those seen upon presentation (7,14).…”

Cardiac structure and function

“…Myocarditis. Myocarditis following smallpox vaccination was presented by Dr. Eckart from the Army Medical Centers (27). Fifty-three military personnel developed probable acute myopericarditis following smallpox vaccination.…”