Myocarditis: A Rare Cardiac Manifestation of Antiphospholipid Syndrome

Abstract

Antiphospholipid syndrome (APS) is known for thrombotic events and pregnancy complications, but its association with myocarditis is rare and poorly understood. A 44-year-old woman presented with acute chest tightness, elevated cardiac biomarkers, and severe anemia. Diagnostic workup revealed ST-segment changes on electrocardiogram, preserved left ventricular function on echocardiography, and myocardial inflammation on cardiac magnetic resonance imaging, suggestive of acute myocarditis. Positive antiphospholipid antibodies confirmed APS. She was managed with close multidisciplinary follow-up. APS-associated myocarditis poses diagnostic challenges because of its atypical presentation and overlap with other cardiac conditions. This case highlights the role of cardiac magnetic resonance imaging in diagnosing myocarditis early, guiding management strategies, and the need for heightened clinical suspicion in APS patients presenting with cardiac symptoms.

Keywords: cardiac magnetic resonance; cardiomypathy; chest pain; echocardiography; imaging; percutaneous coronary intervention; right-sided catheterization.

Graphical abstract

Figure 1

ECG Showing ST-Segment Depressions in Leads II, III, aVF, V₄-V₆, I and aVL, and ST-Segment Elevation in aVR With Anteroseptal Q Waves

Figure 2

Coronary Angiography RAO CAU View Showing Minimal Luminal Irregularities in the Left Circumflex Coronary Artery and Left Anterior Descending Artery

Figure 3

Coronary Angiography Showing the Right Coronary Artery With Minimal Luminal Irregularities

Figure 4

Cardiac MRI With Late Gadolinium Enhancement in the Mid-Myocardial Basal Lateral Segment, Mid Septal, and Apical Lateral Segments Suggestive of Acute Myocarditis Cardiac magnetic resonance imaging with late gadolinium enhancement (white arrows) in the midmyocardial basal lateral segment (left), midseptal (middle) segment, and apical lateral segment (right) suggestive of acute myocarditis.