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'Clinically suspected myocarditis with pseudoinfarct presentation' complicated with left ventricular aneurysm

Annick Haouzi1, Ahmed Ahmed2

  • 1Heart and Vascular Institute, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.

BMJ Case Reports
|January 20, 2018
PubMed

Insights

Acute myocarditis can rarely cause transmural myocardial necrosis and aneurysm, mimicking a heart attack. This case highlights an unusual complication of myocarditis, emphasizing careful monitoring for pseudoinfarct presentations.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Pathology

Background:

  • Myocarditis is an inflammatory condition of the heart muscle.
  • Pseudoinfarct presentation of myocarditis can mimic acute myocardial infarction.
  • Transthoracic echocardiography (TTE) and Cardiac Magnetic Resonance (CMR) are key diagnostic tools.

Observation:

  • A 51-year-old man presented with symptoms suggestive of myocardial infarction but had a normal coronary angiogram.
  • Cardiac MR revealed findings typical of myocarditis, including edema and late gadolinium enhancement.
  • An apical transmural scar with aneurysm developed rapidly within two weeks, an atypical evolution for myocarditis.

Findings:

  • The patient developed an apical transmural myocardial necrosis with aneurysm, an unusual complication of acute myocarditis.
  • Persistent Q waves and apical aneurysm were noted on TTE seven years later.
  • This case underscores the potential for severe, infarct-like complications in myocarditis.

Implications:

  • Myocarditis should be considered in patients with pseudoinfarct presentations, even with normal coronary arteries.
  • Close monitoring is crucial for patients diagnosed with myocarditis due to the risk of atypical complications.
  • Understanding these rare complications can improve diagnostic accuracy and patient management strategies.

Keywords:
cardiovascular medicineclinical diagnostic testsradiology (diagnostics)

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