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ST Segment Elevation Is Not Always Myocardial Infarction: A Case of Focal Myopericarditis

Cyrus M Munguti1, Samuel Akidiva1, Jacob Wallace2

  • 1Internal Medicine Department, University of Kansas Medical School, Wichita, KS, USA.

Case Reports in Cardiology
|January 11, 2018
PubMed

Insights

ST-elevation myocardial infarction (STEMI) protocols are established, but some patients present with similar symptoms due to non-coronary causes. We describe a case diagnosed with focal myopericarditis mimicking STEMI.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Medicine

Background:

  • Established protocols guide the management of ST-elevation myocardial infarction (STEMI) with strict timelines.
  • Some patients exhibit STEMI-like symptoms (chest pain, ECG changes, biomarker elevation) without coronary artery disease.
  • These non-atherosclerotic conditions often present with normal coronary angiography, posing diagnostic challenges.

Observation:

  • A case presented with clinical features indistinguishable from acute STEMI.
  • Standard coronary angiography revealed no obstructive coronary artery disease.
  • The patient experienced chest pain, ST-segment elevation, and elevated cardiac biomarkers.

Findings:

  • Cardiac magnetic resonance (CMR) imaging was crucial for accurate diagnosis.
  • Focal myopericarditis was identified as the underlying cause.
  • This diagnosis explained the STEMI-like presentation without coronary occlusion.

Implications:

  • Highlights the importance of considering non-coronary causes in STEMI presentations.
  • Emphasizes the diagnostic utility of cardiac MRI in differentiating myocardial infarction from other conditions.
  • Suggests potential need for revised diagnostic algorithms to include advanced imaging for challenging cases.

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