Sudden ST elevation with angina-like pain in myocarditis. An uncommon course of a common disease: strategic role of cardiac magnetic resonance

“…However, there has been uncertainty concerning the mechanism of coronary artery vasospasm associated with myocarditis and there are opinions that coronary vasospasm depends on the property of the invading virus [7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Phantom Ischemia Mimicking ST Segment Elevation Myocardial Infarction in Fulminant Myocarditis

Kim

Lee

et al. 2012

Ewha Med J

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A 30-year-old man visited the emergency room for chest pain, dyspnea and fever. Despite increased serum cardiac enzymes, ST segment elevation and inferior wall akinesis in electrocardiography and echocardiography, no atherosclerosis was evident in the coronary angiography. However, radionuclide myocardial perfusion image at day 2 showed a persistent perfusion defect in the left ventricular (LV) inferior wall. At day 3, prominent myocardial edema and severe LV systolic dysfunction developed with signs of heart failure. In this case, fulminant myocarditis seemed to originate from the right coronary artery territory and simulated a ST segment elevation myocardial infarction without coronary artery obstruction. The pathogenesis of the localized perfusion defect was unlcear. (Ewha Med J 2012;35(2):129-134)

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“…8,9 This focal myocardial enhancement can act as an effective guide to endomyocardial biopsy and improves the sensitivity of tissue sampling; otherwise biopsy sensitivity is limited due to the focal nature of the eosinophilic infiltration, resulting in affected sites frequently being missed. 2 The localized nature of the myocardial damage is the result of patchy eosinophilic degranulation.…”

Section: Commentmentioning

confidence: 99%

Eosinophilic myocarditis presenting as acute myocardial infarction

Bleakley¹,

McEneaney²

2011

Journal of Cardiovascular Medicine

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To the editorWith the recent interest in monoclonal antibody therapy in hypereosinophilic syndromes, we present the case of a 53-year-old lady admitted complaining of acute central chest pain and dyspnoea. This was a previously well patient with no significant ischaemic risk factors; however, admission electrocardiogram ( Fig. 1) showed lateral T-wave inversion together with an elevated troponin T of 2.18 ng/ml, leading to a provisional diagnosis of a first presentation myocardial infarction. Therefore, dual antiplatelet therapy and low molecular weight heparin were commenced with resolution of the chest discomfort. A transthoracic echocardiogram demonstrated a localized pericardial effusion and moderate global impairment of left ventricular (LV) systolic function rather than the expected regional wall deficit, which raised the possibility of an inflammatory as opposed to infarctive process. Elevated inflammatory indices included a total white cell count of 20 Â 10 9 /l with a predominant eosinophilia (65%) and these findings, together with subsequently normal coronary angiography, resulted in the assumed diagnosis of infarction being amended to that of eosinophilic myocarditis. This was confirmed on endomyocardial biopsy (Fig. 2) with concurrent bone marrow (Fig. 3) and gastric involvement seen on histopathology. In the absence of a secondary cause, a diagnosis of idiopathic hypereosinophilic syndrome was made according to the criteria outlined by Chusid et al. (Fig. 4). 1 Consequently, dual antiplatelet therapy was discontinued and the patient commenced on interferon-alpha, prednisolone and trandolapril with good clinical effect and complete resolution of the peripheral eosinophilia. Despite the initial moderate LV impairment with an ejection fraction of less than 35%, there was full recovery of LV systolic function within a few months of presentation and the initial acute ECG changes that had contributed to the assumption of ischaemia also improved progressively (Figs 5 and 6).

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Sudden ST elevation with angina-like pain in myocarditis. An uncommon course of a common disease: strategic role of cardiac magnetic resonance

Abstract: A case of a young man with myocarditis simulating acute coronary syndrome is reported. The possibility of vasospasm is discussed. The use of cardiac magnetic resonance imaging (MRI) is highlighted.

Cited by 8 publications

References 6 publications

Aborted sudden death from Epstein–Barr myocarditis

Aborted sudden death from Epstein–Barr myocarditis

Phantom Ischemia Mimicking ST Segment Elevation Myocardial Infarction in Fulminant Myocarditis

Eosinophilic myocarditis presenting as acute myocardial infarction

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