Myocarditis Presenting as ST-Elevation Myocardial Infarction

Abstract

When evaluating a patient with ST-segment elevation on ECG and acute chest pain, providers often rapidly arrive at the diagnosis of ST-elevation myocardial infarction (STEMI). As myocardial infarction is deadly and time is of the essence in establishing reperfusion, it is reasonable to place it at the top of the differential. However, doing so should not come at the expense of conducting a thorough clinical evaluation, considering all causes of ST-segment elevation, and creating a comprehensive differential. Myocarditis, in particular, can present similarly to myocardial infarction and misdiagnosis can lead to unnecessary and sometimes harmful interventions such as thrombolytic therapy, vasodilator therapy, or coronary angiography. We present a case of myocarditis mimicking STEMI and discuss diagnosis and treatment of myocarditis.

Perimyocarditis Associated with Immune Checkpoint Inhibitors: A Case Report and Review of the Literature

“…Moreover, certain indicators in a patient's history that could guide a physician to the correct diagnosis might be either too sensitive for the patient to discuss, such as a history of drug use or HIV, or may not register as noteworthy to the patient, including recent flu-like symptoms or vaccinations. Therefore, it is incumbent upon the physician to gather a comprehensive history, probing for information specific to the potential diagnosis [85][86][87].…”

“…Additionally, cardiac MRI (CMR) offers a non-invasive means of tissue characterization for the myocardium, aiding in the diagnosis of myocarditis. While distinguishing between myocarditis and STEMI can be challenging in some scenarios, a combination of CMR, comprehensive history-taking, and adherence to diagnostic criteria for clinically suspected myocarditis can collectively heighten the suspicion of myocarditis [85][86][87].…”

“…According to this consensus, a diagnosis of myocarditis can be established when at least two of the following features are present: the presence of non-ischemic late gadolinium enhancement in one area, global or regional signal increase in T2-weighted images, and global early gadolinium enhancement. Additionally, CMR studies can offer valuable insights into morphological and functional aspects, contributing to a more comprehensive investigative approach [87][88][89][90].…”