Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.415
Peer-review started: September 19, 2019
First decision: December 4, 2019
Revised: December 17, 2019
Accepted: December 22, 2019
Article in press: December 22, 2019
Published online: January 26, 2020
Processing time: 119 Days and 15.9 Hours
Myocarditis refers to a variety of myocardial inflammatory lesions. A variety of factors such as infection and physical and chemical factors can cause myocarditis. Depending on the severity of myocardial damage, myocarditis patients can manifest heart failure, cardiogenic shock, and even sudden death. Here we present a case of viral myocarditis that mimicked acute coronary syndrome.
A middle-aged male patient presented with chest pain and elevated troponin I after a flu-like infection. This patient had a history of hypertension and a habit of alcohol and tobacco use. Electrocardiography showed typical changes in acute myocardial infarction, with the T-wave increasing. Coronary angiogram revealed no stenosis. Cardiac magnetic resonance imaging revealed edema of the middle and apical septal and apical anterior walls on T2-weighted images and the T1 mapping. Late gadolinium enhancement of the middle and apical septal and apical anterior walls could be found. Rubella virus immunoglobulin G and immunoglobulin M antibodies were abnormally elevated. The patient was given antiviral and antibiotic treatments, and serum biomarkers and electrocardiograph returned to normal after 5 d of treatment. After one-year follow-up, the patient showed no symptoms, and cardiac magnetic resonance showed that myocardial thickness was significantly thinner than before, and fibrosis was less than before.
This case illustrates the utility of cardiac magnetic resonance for diagnosis of infarction-like myocarditis when the angiogram is normal.
Core tip: We present a case of myocarditis with typical acute myocardial infarction symptoms. The diagnosis was confirmed by cardiac magnetic resonance. We followed the patients up to 13 mo, and performed three times of cardiac magnetic resonance. We observed the changes of the myocardial edema and the area of enhancement. We also discuss myocarditis that mimics acute myocardial infraction in order to help clinicians improve their diagnosis and treatment skills.