Bewildering ST-Elevation With Wellens’ Electrocardiogram Pattern – Is Myocarditis in Your Differentials?

Abstract

Myocarditis is the inflammation of the myocardium and is a challenging diagnosis owing to the heterogeneity in its etiology, pathogenesis and clinical presentations. It often presents as an acute coronary syndrome (ACS) mimic and hence may pose both diagnostic and therapeutic challenges to treating physicians to reliably differentiate between these two entities. In this case, we discuss a young male whose initial presentation of chest pain was dubious of the acute coronary syndrome but detailed history, physical examination and by careful selection of non-invasive investigations including echo and cardiac magnetic resonance imaging (MRI), led to a diagnosis of acute myocarditis. This approach not only avoided undue radiation exposure to a young individual but also eluded the unnecessary treatment with potent antiplatelet and anticoagulation therapy.

Left anterior descending coronary T-wave inversion pattern (Wellens’ syndrome) associated with myopericarditis and a normal left coronary artery

“…Hence, its use is limited to cases of diffuse/significant myocardial involvement with LV dysfunction, or a malignant course of LV systolic dysfunction or when symptoms are not responsive to conventional medical management [5] . Hussain et al described a case of myocarditis in association with the Wellens' EKG pattern in a 19-year-old patient without any coronary risk factors [10] . On the contrary, our patient had hypertension, hyperlipidaemia, obesity (multiple risk factors for coronary artery disease) and was found to have combination of myopericarditis instead of just myocarditis.…”

“…Hussain et al described a case of myocarditis in association with the Wellens’ EKG pattern in a 19-year-old patient without any coronary risk factors [ 10 ] . On the contrary, our patient had hypertension, hyperlipidaemia, obesity (multiple risk factors for coronary artery disease) and was found to have combination of myopericarditis instead of just myocarditis.…”