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[Acute myocarditis simulating an anterior infarction rupture. Apropos of 2 cases]
Insights
Two cases of cardiogenic shock were initially misdiagnosed as myocardial infarction. One patient recovered fully, while the other was diagnosed with acute myocarditis caused by Chlamydia trachomatis.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Myocardial infarction and myocarditis can present with similar cardiogenic shock symptoms.
- Accurate diagnosis is crucial for appropriate treatment and patient outcomes.
Observation:
- Two adult patients presented with cardiogenic shock, initially suspected as myocardial infarction.
- Both patients had normal coronary angiography results.
- One case was diagnosed as acute myocarditis linked to Chlamydia trachomatis infection.
Findings:
- The first patient, a 31-year-old woman, recovered fully from presumed anteroseptal myocardial infarction.
- The second patient, a 37-year-old man, was diagnosed with acute myocarditis, with Chlamydia trachomatis identified as the likely cause.
- This is the first reported adult case of Chlamydia trachomatis-associated acute myocarditis.
Implications:
- Highlights the importance of considering infectious etiologies, such as Chlamydia trachomatis, in cases of acute myocarditis presenting as cardiogenic shock.
- Suggests that normal coronary angiography does not rule out acute myocardial conditions.
- Emphasizes the need for comprehensive diagnostic workups to differentiate between myocardial infarction and myocarditis.
Abstract:
The first case report concerns a 31 year old woman presenting clinically and electrocardiographically as an anteroseptal myocardial infarction complicated by cardiogenic shock with equalization of right heart diastolic pressures. Coronary angiography performed under circulatory assistance was normal. The patient recovered, and clinical examination 4 years after the acute episode is absolutely normal. The second case was a 37 year old man admitted in cardiogenic shock thought to be due to a large anterior myocardial infarct. Catheterisation showed equalization of right heart diastolic pressures. Pericardial aspiration was negative and the most likely diagnosis appeared to be a localised rupture of the heart. The patient underwent emergency cardiac surgery but no infarct scar was observed and opening the pericardium did not improve the haemodynamics. Coronary angiography was carried out at the 24th hour under circulatory assistance and was found to be normal. The diagnosis was corrected to that of acute myocarditis and 5 months after the acute episode clinical cure was confirmed by normal echocardiography and angiography. The only positive aetiological finding in this case was the serology to chlamydia trachomatis which as strongly positive at increasing titres. Chlamydia was isolated from the patient's urethra and a chlamydia trachomatis exocervicitis was also found in the partner. This appears to be the first reported case of chlamydia trachomatis acute myocarditis in the adult.