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Streptococcal pharyngitis associated myocarditis (SPAM): the perfect ST-segment elevation myocardial infarction

Theodoros Kalpakos1,2, Adriaan Wilgenhof1,2, Vincent Michiels1

  • 1Department of Cardiology, University Hospital of Brussels, VUB, Brussels, Belgium.

Acta Cardiologica
|December 7, 2020
PubMed
Abstract

Insights

Streptococcal pharyngitis associated myocarditis (SPAM) is a rare cause of ST-segment elevation myocardial infarction (STEMI) in young people. Prompt diagnosis and antibiotic treatment lead to a favorable short-term prognosis.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Internal Medicine

Background:

  • ST-segment elevation myocardial infarction (STEMI) without obstructive coronary artery disease occurs in 5-6% of cases.
  • Myocarditis accounts for one-third of these STEMI cases.
  • Streptococcal pharyngitis associated myocarditis (SPAM) is a rare condition presenting as STEMI post-streptococcal pharyngitis.

Purpose of the Study:

  • To describe the clinical presentation, diagnosis, and outcome of SPAM.
  • To highlight SPAM as a differential diagnosis for STEMI in young individuals.

Main Methods:

  • Case report of two young patients with SPAM.
  • Diagnostic tools included throat culture, electrocardiogram (ECG), coronary angiography, and cardiac imaging.
  • Treatment involved intravenous antibiotics.

Main Results:

  • Both patients presented with STEMI on ECG and had positive streptococcal throat cultures.
  • Coronary angiography revealed no obstructive coronary artery disease; cardiac imaging confirmed myocarditis.
  • Patients experienced rapid clinical recovery with antibiotics, showing no residual cardiac dysfunction post-discharge.

Conclusions:

  • SPAM is an uncommon cause of STEMI, predominantly affecting young individuals.
  • Clinical suspicion of recent pharyngitis, confirmed by throat culture and cardiac imaging, aids diagnosis.
  • Coronary angiography is crucial to rule out obstructive coronary artery disease.
  • Group A Streptococcus is a likely cause, with Group B Streptococcus being a rare possibility.
  • The short-term prognosis for SPAM is generally favorable.
Keywords:
MyocarditisSPAMSTEMIcase seriesstreptococcal pharyngitis

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