Acute myocardial-infarction-like findings with myocarditis in infancy. A case report

Area of Science:

• Pediatric Cardiology
• Pediatric Critical Care Medicine
• Cardiovascular Pathology

Background:

• Sudden circulatory collapse in infants can be life-threatening.
• Myocardial infarction in infants is often associated with congenital coronary artery anomalies.
• Differentiating myocarditis from myocardial ischemia is critical for appropriate management.

Purpose of the Study:

• To describe a unique case of infant myocarditis presenting as myocardial infarction.
• To highlight the diagnostic challenges in differentiating cardiac conditions in infants.
• To emphasize the importance of considering inflammatory processes in infant cardiac emergencies.

Main Methods:

• Case report of a four-and-a-half-month-old infant with sudden circulatory collapse.
• Electrocardiogram (ECG) monitoring and echocardiography.
• Coronary angiography to assess coronary artery anatomy.
• Gallium 67 myocardial imaging to evaluate for inflammation.

Main Results:

• The infant presented with febrile illness and circulatory collapse.
• ECG showed changes indicative of myocardial infarction after initial stabilization.
• Coronary angiography revealed a single origin of the coronary system from the left sinus of Valsalva, with otherwise normal anatomy and flow.
• Gallium 67 imaging confirmed an inflammatory process, supporting myocarditis.
• This presentation mimicked myocardial ischemia in an infant.

Conclusions:

• Myocarditis can present atypically in infants, simulating myocardial infarction.
• Anomalous coronary artery origin should be investigated, but inflammatory causes like myocarditis must also be considered.
• This case underscores the need for comprehensive diagnostic approaches in pediatric cardiac emergencies.