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'Clinically suspected myocarditis with pseudoinfarct presentation' complicated with left ventricular aneurysm
1Heart and Vascular Institute, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
BMJ Case Reports
|January 20, 2018
Summary
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.
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