Recognition of Acute Myocarditis Masquerading as Acute Myocardial Infarction

Open Access
Publisher Website
Google Scholar
Abstract
Myocarditis occasionally masquerades as acute myocardial infarction because patients may present with severe chest pain, electrocardiographic changes, and elevated serum levels of creatine kinase. In patients with normal coronary arteries who presumably died of acute myocardial infarction, myocarditis has been reported as an incidental abnormality at autopsy1-4. Although there have been anecdotal clinical reports of myocarditis mimicking myocardial infarction in patients with normal coronary arteries, this association has almost always relied on a demonstration of diffuse electrocardiographic abnormalities or a preceding viral illness in young patients with few coronary risk factors5-7. In most cases no definitive diagnosis was sought after the patient was found to have normal coronary arteries, and the presence of myocarditis in this setting has only rarely been documented during life by endomyocardial biopsy8,9. The ability to recognize myocarditis in patients presumed to have myocardial infarction would be valuable because abnormal ventricular function generally resolves rapidly in such patients and their long-term outcome is usually good7,9.