Myocarditis with ST elevation and elevated cardiac enzymes misdiagnosed as an ST-elevation myocardial infarction

Seth H. Sheldon, Mark A. Crandall, Allan S. Jaffe

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Acute myocarditis can mimic ST-elevation myocardial infarction (STEMI). Quickly determining the correct diagnosis is critical given the "time is muscle" implication with a STEMI and the potential adverse effects associated with use of fibrinolytic therapy. Case Report: A 46-year-old man presented to a rural emergency department with chest pain, and an electrocardiogram (ECG) read as showing 0.1 mV of ST-segment elevation in leads III and aVF. His initial cardiac troponin T was 0.44 ng/mL. He received fibrinolytic therapy for presumed STEMI. Cardiac magnetic resonance imaging was later performed and showed epicardial delayed enhancement consistent with myocarditis. Upon further questioning, he acknowledged 3 days of stuttering chest discomfort and a recent upper respiratory infection, as well as similar chest pain in his wife. Conclusions: A systematic evaluation is essential for acute chest pain, including a focused history, identification of cardiac risk factors, and ECG interpretation. A history of recent viral illness, absence of cardiac risk factors, or ECG findings inconsistent with a single anatomic lesion would suggest a potential alternate diagnosis to STEMI. This case emphasizes the importance of a focused history in the initial evaluation of chest pain.

Original languageEnglish (US)
Pages (from-to)996-999
Number of pages4
JournalJournal of Emergency Medicine
Volume43
Issue number6
DOIs
StatePublished - Dec 2012

Keywords

  • Chest pain
  • Electrocardiogram pattern
  • Electrocardiography
  • Myocardial infarction
  • Myocarditis
  • ST-segment elevation

ASJC Scopus subject areas

  • Emergency Medicine

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