Download CR 10: Myocarditis mimicking an acute coronary syndrome

CR 10: Myocarditis
mimicking an acute
coronary syndrome.
Contribution of cardiac MRI
Sdiri W., Mbarek D., Tlili R., Ben Ameur Y., Boujnah M. R.
Cardiology Departement – Mongi Slim University Hospital
La Marsa – TUNISIA
Background
• Myocarditis is an inflammation of
myocardium usually due to a viral infection.
• Clinical presentation: Heart failure + Fever
• Rarely: chest pain mimicking acute
coronary syndromes.
Case report
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A 42 years-old man.
CV risk factors: smoking
Admitted to our CCU for prolonged chest pain.
Physical exam:
Temperature:37.2°C
Blood pressure: 14/9
Cardiac auscultation: nomal
No cardiac failure.
ECG
Electrocardiogram showed neither Q waves, nor repolarization abnormalities.
Chest X-Ray
Biology
• White blood cells=11.000el/mm3
• Hb= 16.4g/dl
• Creatinin=63µmol/l
• Troponin=1.44ng/l
• CPK=348UI/l
Positive
Echocardiography
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LVd=48mm
LVs=30mm
EF=61%
No abnormal wall motion
• The diagnosis of Non ST Segment Elevation
acute coronary syndrome was considered.
• The patient received anti-ischemic treatment.
• Coronary angiogram: normal.
An acute myocarditis was suspected.
Cardiac MRI
RV
LV
Short axis view: subepicardial late enhacement
involving the antero-septal wall
• The diagnosis of myocarditis was
finally retained.
• The anti-ischemic treatment was
stopped.
• After 6-month follow-up, the patient
is still asymptomatic.
Conclusion:
• Cardiac MRI is the gold standard for
detecting
myocardial
infarction
(subendocardial or transmural enhacement).
• It also allows easily the diagnosis of
myocarditis (subepicardial late enhacement).
• In a context of acute chest pain, Cardiac
MRI should be performed if ECG,
echocardiogram or coronary angiogram are
not conclusive.