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Myocarditis simulating acute transmural myocardial infarction
S Chakko1, D Woska, E de Marchena
1University of Miami School of Medicine, Jackson Memorial Hospital, Florida.
Insights
Myocarditis can mimic myocardial infarction on ECGs, leading to misdiagnosis. Cardiac catheterization is crucial for differentiating these conditions before initiating treatment.
Area of Science:
- Cardiology
- Pathology
Background:
- Acute myocardial infarction (AMI) is a leading cause of cardiogenic shock.
- Electrocardiography (ECG) is a primary diagnostic tool for identifying ST-elevation myocardial infarction (STEMI).
Observation:
- A patient presented with cardiogenic shock and ECG findings typical of acute anterior transmural myocardial infarction.
- Cardiac catheterization revealed normal coronary arteries but severe biventricular failure.
Findings:
- Postmortem examination identified acute myocarditis without evidence of infarction.
- ECG changes in myocarditis can be indistinguishable from acute transmural infarction.
Implications:
- Myocarditis diagnosis requires careful consideration, especially when ECGs suggest infarction.
- Cardiac catheterization is recommended to rule out infarction before thrombolytic therapy in suspected cases.
- Accurate diagnosis is critical to guide appropriate management and improve patient outcomes.
Abstract:
A patient with cardiogenic shock had typical electrocardiographic findings of acute anterior transmural myocardial infarction. Cardiac catheterization revealed normal coronary arteries and severe biventricular failure. Postmortem examination confirmed normal coronary arteries; acute myocarditis, but no evidence for infarction, was found. Electrocardiographic changes of myocarditis may be indistinguishable from acute transmural infarction. In suspected cases, cardiac catheterization should be considered prior to thrombolytic therapy.