Bewildering ST-Elevation With Wellens' Electrocardiogram Pattern - Is Myocarditis in Your Differentials?
Ali Hussain1, Mubashar Iqbal2, Gondal Mohsin3
1Acute Medicine, Pinderfields General Hospital, Wakefield, GBR.
Cureus
|March 3, 2021
Summary
Diagnosing myocarditis, or heart muscle inflammation, can be challenging as it mimics acute coronary syndrome. This case highlights how careful non-invasive testing accurately identified myocarditis, avoiding unnecessary treatments.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Myocarditis, inflammation of the heart muscle, presents diagnostic challenges due to varied causes and symptoms.
- It frequently mimics acute coronary syndrome (ACS), complicating differentiation for clinicians.
Observation:
- A young male presented with chest pain initially suspected as ACS.
- Detailed patient history, physical examination, and targeted non-invasive imaging were crucial.
Findings:
- Echocardiography and cardiac magnetic resonance imaging (MRI) confirmed acute myocarditis.
- This diagnostic pathway successfully distinguished myocarditis from ACS.
Implications:
- Accurate non-invasive diagnosis of myocarditis avoids unnecessary radiation exposure in young patients.
- Correctly identifying myocarditis prevents inappropriate use of potent antiplatelet and anticoagulation therapies.
Related Concept Videos
01:27Myocarditis II: Clinical Features and Diagnostic Tests
96
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
96
01:29Electrocardiogram
4.6K
An electrocardiogram (ECG or EKG) is a critical diagnostic tool that records the electrical signals produced by the heart during each heartbeat. This recording is achieved through electrodes placed strategically on the arms, legs, and chest. The electrocardiograph amplifies these signals and produces 12 distinct tracings, offering a comprehensive understanding of the heart's electrical activity.
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
4.6K
01:21Myocarditis I: Introduction
153
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
153
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
129
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
129
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
217
The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
217
01:30Acute Coronary Syndrome I: Introduction
281
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
281