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Myocardial infarction and the normal arteriogram--possible role of viral myocarditis
Insights
Viral myocarditis can mimic acute myocardial infarction (heart attack) in patients. This study found that some heart attack diagnoses were actually caused by viral infections, highlighting the importance of considering myocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Acute myocardial infarction (AMI) is a leading cause of death worldwide.
- Electrocardiographic (ECG) findings and serological markers are crucial for diagnosing AMI.
- Viral infections, such as Coxsackie B, can cause myocarditis, an inflammation of the heart muscle.
Purpose of the Study:
- To investigate the potential of viral myocarditis to mimic acute myocardial infarction.
- To identify patients with AMI-like symptoms but without significant coronary artery obstruction.
Main Methods:
- Prospective study of 12 patients diagnosed with non-transmural infarction.
- Serological testing for Coxsackie B infection.
- Coronary arteriography in 11 patients.
Main Results:
- Nine female and three male patients aged 38-60 years were identified.
- Eight of 11 patients (73%) showed no significant coronary arterial obstruction (≥50%).
- Serological evidence of recent Coxsackie B infection was found, suggesting viral myocarditis in at least 6 patients.
Conclusions:
- Viral myocarditis can present with symptoms and ECG findings similar to acute myocardial infarction.
- Coronary artery disease may not be the cause in all patients with myocardial infarction and normal coronary arteriograms.
- Myocarditis should be considered in the differential diagnosis of myocardial infarction, especially with normal coronary arteriography findings.
Abstract:
In a prospective study we identified a group of 12 patients diagnosed as having acute myocardial infarction but with electrocardiographic features of non-transmural infarction and serological evidence of recent Coxsackie B infection favouring the possibility of myocarditis. The group included 9 females and 3 males, aged from 38-60 y. Coronary arteriography was carried out in 11 patients. Eight of the 11 patients showed no significant (greater than or equal to 50%) coronary arterial obstruction. We suggest that coronary artery disease did not contribute to the clinical presentation in the majority of these patients and that the likely diagnosis was viral myocarditis in at least 6 of them. We conclude that viral myocarditis may simulate myocardial infarction and contribute to the uncommon but controversial syndrome of myocardial infarction with a normal coronary arteriogram.