Focal Myopericarditis as a Rare but Important Differential Diagnosis of Myocardial Infarction; a Case Series
Archives of Academic Emergency Medicine,
Vol. 4 No. 3 (2016),
1 August 2016
,
Page 159-162
https://doi.org/10.22037/aaem.v4i3.242
Abstract
Distinguishing ST-elevation myocardial infarction (STEMI) differential diagnoses is more challenging. Myopericarditis is one of these differentials that results from viral involvement of myocardium and pericardium of the heart. Myopericarditis in focal form can mimic acute STEMI in its electrocardiogram (ECG) features and elevated cardiac enzymes.
Myocarditis patients may face thrombolytic related complications such as intracranial bleeding, myocardial rupture, and hemorrhagic cardiac tamponade. Furthermore, re-administration of streptokinase (a common thrombolytic agent in our country) is banned for at least six months of previous administration; however, it can save patients’ lives in emergency conditions such as massive pulmonary embolism. It seems that, when dealing with a young patient presenting to emergency department with acute chest pain and ST segment elevation on ECG, we should consider focal myocarditis as an important but rare differential diagnosis of STEMI. In this report, we describe three cases of focal myocarditis, primarily misdiagnosed as STEMI.
- Coronary angiography
- electrocardiography
- myocardial infarction
- myocarditis
- emergency medicine
How to Cite
References
Tajdini M. Spontaneous myopericarditis in a patient under dexamethasone: A double-edged sword? Journal of the Saudi Heart Association. 2015;27(4):292-4.
Testani JM, Kolansky DM, Litt H, Gerstenfeld EP. Focal Myocarditis Mimicking Acute ST-Elevation Myocardial Infarction. Texas Heart Institute Journal. 2006;33(2).
Chow LH, Radio SJ, Sears TD, Mcmanus BM. Insensitivity of right ventricular endomyocardial biopsy in the diagnosis of myocarditis. Journal of the American College of Cardiology. 1989;14(4):915-20.
Deckers JW, Hare JM, Baughman KL. Complications of transvenous right ventricular endomyocardial biopsy in adult patients with cardiomyopathy: a seven-year survey of 546 consecutive diagnostic procedures in a tertiary referral center. Journal of the American College of Cardiology. 1992;19(1):43-7.
Gahide G, Bertrand D, Roubille F, Tron C, Skaik S, Piot C, et al. MR delayed enhancement imaging findings in suspected acute myocarditis. European radiology. 2010;20(1):65-72.
Mahrholdt H, Wagner A, Judd RM, Sechtem U, Kim RJ. Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. European heart journal. 2005;26(15):1461-74.
Ohman EM, Topol EJ, Califf RM, Bates ER, Ellis SG, Kereiakes DJ, et al. An analysis of the cause of early mortality after administration of thrombolytic therapy. Coronary artery disease. 1993;4(11):957-64.
Califf RM, Fortin DF, Tenaglia AN, Sane DC. Clinical risks of thrombolytic therapy. The American journal of cardiology. 1992;69(2):A12-A20.
Dennert R, Crijns HJ, Heymans S. Acute viral myocarditis. European heart journal. 2008.
Schultz JC, Hilliard AA, Cooper LT, Rihal CS, editors. Diagnosis and treatment of viral myocarditis. Mayo Clinic Proceedings; 2009: Elsevier.
Brady WJ, Ferguson JD, Ullman EA, Perron AD. Myocarditis: emergency department recognition and management. Emergency medicine clinics of North America. 2004;22(4):865-85.
Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H, et al. Cardiovascular magnetic resonance assessment of human myocarditis a comparison to histology and molecular pathology. Circulation. 2004;109(10):1250-8.
Axsom K, Lin F, Weinsaft JW, Min JK. Evaluation of myocarditis with delayed-enhancement computed tomography. Journal of cardiovascular computed tomography. 2009;3(6):409-11.
Hsiao J-F, Bonnichsen CR, Koshino Y, Saleh HK, Yu Y, Pellikka PA, et al. Left Ventricular Deformation by 2-D Speckle Tracking Echocardiogram for the Diagnosis of Acute Myocarditis With Preserved LV Ejection Fraction. Circulation. 2010;122(21 Supplement):A20570.
Zhang C, Shen D, Sun H, Zhang L, Ma Y, Huang D. [Prognostic value of brain natriuretic peptide in people with viral myocarditis]. Zhonghua shi yan he lin chuang bing du xue za zhi= Zhonghua shiyan he linchuang bingduxue zazhi= Chinese journal of experimental and clinical virology. 2012;26(2):125-6.
Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European heart journal. 2013;34(33):2636-48.
- Abstract Viewed: 351 times
- PDF Downloaded: 171 times
- HTML Downloaded: 92 times
