Myocarditis Presenting as ST-Elevation Myocardial Infarction
Fahad Hussain1,2, Carmel Moazez3, Kathleen Allen4
1Internal Medicine, Northwell Health, Manhasset, USA.
Insights
ST-segment elevation on ECG and chest pain can mimic ST-elevation myocardial infarction (STEMI). This case highlights myocarditis as a critical differential diagnosis to avoid harmful interventions.
Area of Science:
- Cardiology
- Internal Medicine
- Emergency Medicine
Background:
- ST-segment elevation on electrocardiogram (ECG) with acute chest pain often leads to a rapid diagnosis of ST-elevation myocardial infarction (STEMI).
- Prompt reperfusion therapy is crucial for STEMI due to its high mortality rate.
- However, other conditions can present with ST-segment elevation, necessitating a broad differential diagnosis.
Abstract:
When evaluating a patient with ST-segment elevation on ECG and acute chest pain, providers often rapidly arrive at the diagnosis of ST-elevation myocardial infarction (STEMI). As myocardial infarction is deadly and time is of the essence in establishing reperfusion, it is reasonable to place it at the top of the differential. However, doing so should not come at the expense of conducting a thorough clinical evaluation, considering all causes of ST-segment elevation, and creating a comprehensive differential. Myocarditis, in particular, can present similarly to myocardial infarction and misdiagnosis can lead to unnecessary and sometimes harmful interventions such as thrombolytic therapy, vasodilator therapy, or coronary angiography. We present a case of myocarditis mimicking STEMI and discuss diagnosis and treatment of myocarditis.
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