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"Acute pericarditis": myocardial enzyme release as evidence for myocarditis
Abstract:
The relationship between the serial ECG ST-T wave changes held to be characteristic of acute pericarditis and serum cardiac enzyme levels was studied in 18 young men with symptoms of acute infectious disease. Creatine kinase MB enzyme (CK-MB) was detected in 14 patients (78%); its peak levels were as high as 186 U/L during the first days of ST segment elevation. Normal values were only noted during the subsequent T wave inversion stage of the disease. ST segment elevation was more marked (p less than 0.01) and T wave inversions were deeper (p less than 0.01) and more prolonged (p less than 0.05) in the 12 patients with CK-MB levels over 10 U/L than in those with values under 10 U/L. Pericardial friction rub and/or pericardial effusion by echocardiography occurred in only one third of the patients. We conclude that the serial ECG changes of ST segment elevation, with subsequent T wave inversions in connection with acute infection, are caused by acute myocardial injury, myocarditis, as reflected by myocardial enzyme release.
Insights
Acute pericarditis ECG changes, specifically ST-T wave alterations, indicate acute myocardial injury and myocarditis. This is confirmed by elevated cardiac enzyme levels, such as creatine kinase MB (CK-MB), during infection.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- Acute pericarditis is often associated with ST-T wave changes on electrocardiograms (ECGs).
- The correlation between these ECG findings and cardiac enzyme levels in infectious cases is not fully understood.
Purpose of the Study:
- To investigate the relationship between serial ECG ST-T wave changes and serum cardiac enzyme levels in young men with acute infectious disease.
Main Methods:
- Studied 18 young men with symptoms of acute infectious disease.
- Monitored serial ECGs for ST-T wave changes.
- Measured serum creatine kinase MB (CK-MB) levels.
Main Results:
- Creatine kinase MB (CK-MB) was detected in 78% of patients, peaking during ST segment elevation.
- More pronounced ST segment elevation and deeper, prolonged T wave inversions were observed in patients with higher CK-MB levels (>10 U/L).
- Clinical signs of pericarditis (friction rub/effusion) were infrequent.
Conclusions:
- Serial ECG changes (ST elevation, T wave inversion) in acute infections reflect acute myocardial injury (myocarditis).
- Myocardial enzyme release, indicated by elevated CK-MB, supports the diagnosis of myocarditis in these cases.