Acute myocarditis mimicking ST-elevation myocardial infarction: A case report and review of the literature

Abstract

The present study describes the case of a young man aged 22 who had acute retrosternal pain, elevated cardiac markers and electrocardiographic ST-T changes, which led to an original misdiagnosis of acute myocardial infarction. The patient underwent immediate coronary angiography, which revealed normal coronary arteries. Finally, the diagnosis of viral myocarditis was made on consideration of his fever, scattered red dots on his arms and legs and other auxiliary examination results obtained in the following days, which were supportive of the diagnosis. The patient improved on antiviral and myocardial protection therapy and was discharged 2 weeks later. Viral myocarditis is a common disease with a variable natural history. It remains challenging for doctors to differentiate between acute myocarditis and myocardial infarction, particularly in the early stages. A diagnosis of myocarditis should be made on the basis of synthetic evaluation of the evidence, including medical history, clinical presentation and results of the available auxiliary tests, in order to provide guidelines for treatment.

Keywords: ST-elevation; coronary angiography; myocardial infarction; viral myocarditis.

Figure 1.

Twelve-lead surface electrocardiogram showing extensive ST-segment elevation in leads II, III and aVF (June 18, 2012).

Figure 2.

Coronary angiography revealing normal epicardial coronary arteries (June 18, 2012). LAD, left anterior descending coronary artery; LCX, left circumflex artery; RCA, right coronary artery.

Figure 3.

Review of the electrocardiogram on the ninth day demonstrated that the elevated ST segment in leads II, III and aVF had fallen back to the baseline level, coupled with T-wave inversion (June 26, 2012).