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Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

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Updated: May 22, 2026

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Published on: December 28, 2012

Atrioventricular Dissociation With Ischemic-Appearing ST-Segment Changes.

Ziad Hindosh1, Elliot Roufeh1, Justin Hayase2

  • 1Olive View-UCLA Medical Center, Department of Medicine, Division of Cardiology.

JACC. Case Reports
|May 21, 2026
PubMed
Summary
This summary is machine-generated.

Fulminant myocarditis can mimic acute coronary syndrome, causing ST-segment elevation and shock. Early diagnosis is crucial as this severe heart inflammation presents a poor prognosis.

Keywords:
acute heart failurecardiomyopathyelectrocardiogramheart blockmyocarditis

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Published on: January 31, 2019

Area of Science:

  • Cardiology
  • Electrophysiology
  • Critical Care Medicine

Background:

  • ST-segment elevation with wide-complex rhythms presents a diagnostic challenge, particularly in shock patients.
  • While acute coronary occlusion is a primary concern, a broad differential diagnosis is essential.

Purpose of the Study:

  • To highlight the importance of considering fulminant myocarditis in the differential diagnosis of ST-segment elevation and shock.
  • To illustrate the clinical presentation and diagnostic challenges associated with severe myocarditis.

Main Methods:

  • Case report of a 46-year-old woman presenting with fever, chest pain, and shock.
  • Electrocardiogram revealed high-grade atrioventricular block, wide-complex rhythm, and anterior ST-segment changes.
  • Coronary angiography excluded acute coronary syndrome, leading to diagnosis of fulminant myocarditis.

Main Results:

  • The patient presented with hemodynamic instability and electrocardiographic findings suggestive of acute coronary syndrome.
  • Coronary angiography revealed normal coronary arteries.
  • The patient was diagnosed with fulminant myocarditis complicated by conduction disease and cardiogenic shock.

Conclusions:

  • Diffuse myocardial inflammation in fulminant myocarditis can cause conduction abnormalities and ST-segment changes mimicking ischemia.
  • Fulminant myocarditis should be considered in patients with inflammatory symptoms, conduction disease, and shock after ruling out acute coronary syndrome.
  • This condition carries a poor prognosis due to severe myocardial damage and conduction disruption.