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Acute myocarditis mimicking lateral myocardial infarction
N Mottard1, N Mewton, E Bonnefoy
1Intensive Care Unit, Hopital Cardiologique Louis Pradel, Lyon, France.
Anaesthesia and Intensive Care
|October 16, 2008
Summary
Myocarditis can mimic heart attack, but delayed-enhanced cardiac CT can rapidly diagnose it in emergencies. Patients with severe symptoms need close monitoring for 72 hours, even if heart attack is ruled out.
Area of Science:
- Cardiology
- Medical Imaging
- Emergency Medicine
Background:
- Myocarditis can present with symptoms mimicking acute myocardial infarction.
- Delayed diagnosis and treatment can lead to severe complications such as ventricular fibrillation.
Observation:
- A case of myocarditis initially treated as acute myocardial infarction presented with ventricular fibrillation.
- Diagnosis was rapidly confirmed using low-dose delayed-enhanced cardiac multidetector computed tomography (DE-CMCT).
- Findings on DE-CMCT correlated well with delayed enhanced magnetic resonance imaging (DE-MRI).
Findings:
- Delayed-enhanced cardiac multidetector computed tomography accurately diagnosed myocarditis in an emergency setting.
- The scan demonstrated typical myocardial late hyperenhancement patterns characteristic of myocarditis.
- Coronary angiography was normal, ruling out obstructive coronary artery disease.
Implications:
- DE-CMCT is a valuable tool for the rapid diagnosis of myocarditis in emergency situations.
- Patients with severe symptoms, ECG changes, and elevated cardiac enzymes require prolonged monitoring (≥72 hours) even after myocardial infarction exclusion.
- This case highlights the importance of considering myocarditis in the differential diagnosis of acute coronary syndromes.
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