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Acute perimyocarditis mimicking transmural myocardial infarction

Hesham R Omar1, Ahmed Fathy, Rania Rashad

  • 1Department of Cardiology, Cairo University Hospital, Cairo, Egypt. hesham_engy2008@yahoo.com.

International Archives of Medicine
|December 17, 2009
PubMed

Insights

Diagnosing acute pericarditis can be challenging when electrocardiogram (ECG) changes mimic ST-segment elevation myocardial infarction (MI), especially with elevated cardiac biomarkers. Accurate differentiation is crucial to avoid harmful treatments and missed diagnoses.

Area of Science:

  • Cardiology
  • Diagnostic Medicine

Background:

  • Acute pericarditis typically presents with diffuse electrocardiographic (ECG) changes.
  • Myocarditis co-occurrence can elevate cardiac biomarkers, complicating differential diagnosis with acute ST-segment elevation myocardial infarction (MI).
  • Misdiagnosis can lead to adverse outcomes, including inappropriate thrombolytic therapy for pericarditis or missed transmural MI.

Purpose of the Study:

  • To highlight the diagnostic challenges in differentiating acute pericarditis from acute ST-segment elevation myocardial infarction (MI).
  • To raise awareness among clinicians regarding overlapping presentations and critical diagnostic considerations.

Main Methods:

  • Case report of an 18-year-old male presenting with severe chest pain.
  • Analysis of focal ECG changes and elevated cardiac enzymes mimicking transmural MI.
  • Review of diagnostic criteria for acute pericarditis and MI.

Main Results:

  • The patient's presentation mimicked acute transmural MI due to focal ECG changes and elevated cardiac enzymes.
  • This case underscores the potential for diagnostic confusion between acute pericarditis and MI.

Conclusions:

  • Accurate differentiation between acute pericarditis and acute ST-segment elevation myocardial infarction (MI) is critical for appropriate patient management.
  • Clinicians should maintain a high index of suspicion for pericarditis even with atypical ECG findings and elevated cardiac biomarkers.

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