Acute coronary syndrome vs. myopericarditis – not always a straightforward diagnosis

Abstract

Patient: Male, 58Final Diagnosis: MyopericarditisSymptoms: Retrosternal thoracic painMedication: —Clinical Procedure: MRISpecialty: CardiologyObjective:Challenging differential diagnosisBackground:Patients with acute cardiac symptoms, elevated cardiac troponin, and culprit-free angiograms are a consistent proportion of patients admitted with presumed acute coronary syndromes (ACS). Current literature on this population of patients justifies the diagnostic importance of cardiovascular magnetic resonance (CMR) imaging.Case Report:This report describes the case of a 58-year-old cyclist in which CMR allowed us to perform a diagnosis of myopericarditis mimicking acute STEMI against other evidence. There are several such reports in literature because the clinical presentation of myocarditis is quite variable.Conclusions:This case report emphasizes the importance of cardiovascular magnetic resonance imaging in the differential diagnosis of the etiology of acute coronary syndromes. This is especially important because the signs and symptoms presented are ambiguous and equivalent to those of other diseases, such as myopericarditis, which affects mainly young athletes but also middle-aged athletes.

Viral myopericarditis masquerading as acute coronary syndrome: Diagnostic role of cardiac MRI

“…Similar observations have been made in patients with myocardial infarction (MI) with nonobstructive coronary arteries, who exhibit clinical evidence of MI, but CAG does not reveal any obstructions [3]. Further, disorders such as small vessel disease, coronary embolism, hematologic disease leading to in situ thrombosis, and congenital anomalies can also cause acute MI in the presence of healthy coronary arteries or without significant stenosis [2]. Hence, it is vital to accurately diagnose patients presenting with signs of ACS and manage them appropriately to prevent further complications.…”

“…yopericarditis often masquerades as an acute coronary syndrome (ACS), due to the common clinical manifestations such as angina pain or even cardiogenic shock and similarities in electrocardiogram (ECG) or echocardiogram changes, along with variations in serum biomarker levels [1]. Although ACS may be attributed to the presence of acute thrombosis or severe obstructive, atherosclerotic disease, which are evident in coronary angiography (CAG) in most cases, this criterion may not be met in a large minority of cases [2]. Similar observations have been made in patients with myocardial infarction (MI) with nonobstructive coronary arteries, who exhibit clinical evidence of MI, but CAG does not reveal any obstructions [3].…”

Acute tuberculous myopericarditis mimicking acute myocardial infarction: A case report and literature review

“…In acute myocarditis, CMR shows an abnormal patchy myocardial signal with delayed enhancement suggesting myonecrosis and edema, without presenting in the subendocardial region, which exclude the diagnosis of CAD (24). In acute myopericarditis, similar findings upon the use of CMR further confirm that the subepicardial myocardium is involved and the subendocardial region is spared (13,16,17). Although biopsy is the main technique used for the diagnosis of myocarditis, it may be of limited clinical value in certain cases, particularly in myopericarditis, where pericardial involvement is prevalent.…”

“…Therefore, the differentiation of acute myopericarditis from AMI is of great importance due to differences in the complications, treatment strategies and prognoses between the two conditions. A large number of studies have investigated the differentiation between acute myopericarditis and AMI since 2008 (6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, to the best of our knowledge, acute myopericarditis resulting from M. tuberculosis infection and simulating AMI has not previously been reported.…”

Severe Coronary Artery Disease Disguised as Myocarditis

“…Although the gold standard for diagnosis is an endomyocardial biopsy, with high specificity, the sensitivity is low, and there are significant risks associated with biopsy. Due to these disadvantages, CMR is the preferred method unless the patient, for some reason, is unable to undergo CMR [9].…”