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. 2020 Nov 7;4(6):1-5.
doi: 10.1093/ehjcr/ytaa347. eCollection 2020 Dec.

An unusual case of apical myocarditis: a case report

Arka Das  1   2 , Ananth Kidambi  1   2 , Sven Plein  1   2 , Erica Dall'Armellina  1   2
Affiliations

An unusual case of apical myocarditis: a case report

Arka Das et al. Eur Heart J Case Rep. .

Abstract

Background: Myocardial infarction with non-obstructed coronary arteries (MINOCA) syndrome accounts for ∼6-8% of acute coronary syndrome presentations. Historically, MINOCA has been thought of as a benign condition, however, recent evidence suggests that some aetiologies of MINOCA such as cardiomyopathies are associated with significantly higher mortality than other causes such as myocarditis. Therefore, identifying the underlying cause of MINOCA is important in determining patient management and prognosis.

Case summary: We describe the case of a 58-year-old lady with an acute admission with MINOCA syndrome. Cardiac magnetic resonance (CMR) examination on Day 9 demonstrated hypertrophy of the apical segments of the left ventricle (LV), with diffuse mid-wall hyper-enhancement on late gadolinium enhancement (LGE) images. T2-weighted imaging was suggestive of active inflammation in the hypertrophied segments. A repeat CMR scan was performed 3 months later showed normalization of LV wall thickness, LGE and T2 values in the apical segments.

Discussion: This case report highlights the benefits of CMR with oedema-weighted imaging in the acute stages of MINOCA syndrome, as well as the importance of serial imaging in this patient cohort. While baseline imaging raised the possibility of apical hypertrophic cardiomyopathy, resolution of apical hypertrophy on follow-up CMR showed that the patient had acute myocarditis, specifically involving the apical segments.

Keywords: Cardiac magnetic resonance; Case report; MINOCA syndrome; Myocarditis; T2-weighted imaging; Takotsubo.

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Figures

Figure 1
Figure 1
Twelve-lead ECG at presentation.
Figure 2
Figure 2
Acute MRI scan. Apical four-chamber view with late gadolinium enhancement (LGE) (A); basal, mid, apical short-axis slices by LGE (B), end-diastole cine (C), and T2-weighted images (D).
Figure 3
Figure 3
Follow-up scan. Apical four-chamber view with late gadolinium enhancement (LGE) (A); basal, mid, apical short-axis slices by LGE (B), end-diastole cine (C), and T2-weighted images (D).
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