Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction

Infectious myocarditis is the result of an immune response to a microbial infection of the heart. The blood vessels of the heart, both the intramyocardial microvasculature and the large epicardial coronary arteries, play an important role in the pathogenesis of infectious myocarditis. First of all, in addition to cardiomyocytes, endothelial cells of the cardiac (micro)vasculature are direct targets for infection. Moreover, through the expression of adhesion molecules and antigen presenting Major Histocompatibility Complex molecules, the blood vessels assist in shaping the cellular immune response in infectious myocarditis. In addition, damage and dysfunction of the cardiac (micro)vasculature are associated with thrombus formation as well as aberrant regulation of vascular tone including coronary vasospasm. These in turn can cause cardiac perfusion abnormalities and even myocardial infarction. In this review, we will discuss the role of the cardiac (micro)vasculature in the pathogenesis of infectious myocarditis.Electronic supplementary materialThe online version of this article (10.1007/s10741-018-9688-x) contains supplementary material, which is available to authorized users.

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“…2 ). [ 126 – 128 ] Already in 1985 vascular spasm in the arterioles and capillaries in mice with Chagas disease was reported. [ 129 ]…”

Section: Effects On Coronary Vasomotor Functionmentioning

confidence: 99%

Infectious myocarditis: the role of the cardiac vasculature

et al. 2018

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“…Myocarditis probably plays a role as autopsy series suggests associated rates of 27–57% in children and as high as 85% in adults [ 5 ]. Acute myocarditis, in general, may present with chest pain, ECG changes, and elevated serum markers, all of which were seen in our case [ 10 ] and may trigger coronary spasm mimicking myocardial infarction [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Meningococcemia Presenting as a Myocardial Infarction

Lachant

Trawick

2015

Case Reports in Critical Care

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Neisseria meningitidis is an encapsulated gram negative diplococcus that colonizes the nasopharynx and is transmitted by aerosol or secretions with the majority of cases occurring in infants and adolescents. Meningococcemia carries a high mortality which is in part due to myocarditis. Early recognition and prompt use of antibiotics improve morbidity and mortality. We report a 55-year-old male presenting to the emergency department with chest pain, shortness of breath, and electrocardiogram changes suggestive of ST elevation MI who developed cardiogenic shock and multisystem organ failure from N. meningitidis. We present this case to highlight the unique presentation of meningococcemia, the association with myocardial dysfunction, and the importance of early recognition and prompt use of antibiotics.

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“…In addition, patients with LM can present with a variety of clinical symptoms suggestive of myocardial infarction (MI), such as chest pain, electrocardiographic ST-segment elevation, wall motion abnormalities and increased blood levels of cardiac enzymes [2][3][4][5][6][7][8][9][10]. Moreover, coronary artery spasms have been reported to occur in patients with LM [11][12][13]. In fact coronary vasospasm was demonstrated in 70.9% of patients with proven LM on endomyocardial biopsy (EMB) who presented with chest pain [11].…”

Section: Introductionmentioning

confidence: 99%