Acute Myocarditis Presenting as Acute Coronary Syndrome

Mosebach, Christian M; Tandon, Varun; Kumar, Manish

doi:10.7759/cureus.5212

Cited by 4 publications

(5 citation statements)

References 7 publications

(8 reference statements)

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“…Therefore, repeatedly reviewing ECGs to observe dynamic changes and compare differences is recommended. Persistent changes in ST segments, R on T waveforms, and high degree atrioventricular blocks are suggestive of a poor prognosis [14]. Paroxysmal atrial tachycardia, low voltage of chest conduction, and severe systolic dysfunction were observed in this case report, indicating that the myocardium was damaged by the 2019-nCoV infection.…”

Section: Discussionmentioning

confidence: 54%

Successful Treatment of a COVID-19 Patient with Fulminant Myocarditis: A Case Report and Review of Literature

Wang¹,

Wang²,

Song³

2022

IJCEMR

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Lung damage is the primary clinical concern when treating Coronavirus Disease 2019 (COVID-19) patients. However, not enough attention has been given to potential myocardial damage associated with COVID-19 infection. Here, we report a 65-year-old woman who diagnosed with COVID-19 and myocarditis based on 2019-nCoV nucleic acid test, electrocardiogram (ECG), and myocardial markers. The patient with fulminant myocarditis who presented with the following: (1) obvious symptoms of pulmonary infection without any cardiac-specific symptoms; (2) alleviation of pulmonary symptoms with worsening myocardial damage after treatment; and (3) sudden cardiac arrest caused by malignant arrhythmia. The patient was administered oral Ambroxol tablets, Arbidol Hydrochloride capsules, Lianhuaqingwen capsules (Traditional chinesemidicine), and Ibuprofen capsules, as well as intravenous Moxifloxacin, 20% human serum albumin, and Imipenem sildastatin sodium. On day 8 after hospitalization, the patient suddenly went into a cardiac arrest.After cardiopulmonary resuscitationand electric defibrillation, the patient's vital sign recovered and was immediately transferred to ICU for further treatment. The patient received high-dose methylprednisolone (500mg/d), immunoglobulin therapy (20g/d), ventilator-assisted ventilation, and extracorporeal membrane pulmonary oxygenation (ECMO).One month later, the patient was in stable condition and discharged home. This case study and the literature indicate that symptoms of myocardial injury caused by COVID-19 may be atypical and may develop prior to the onset of pulmonary symptoms. Therefore, active prevention and early adoption of various treatment measures, even in the absence of myocardial injury, may benefitCOVID-19 patients.

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Section: Discussionmentioning

confidence: 54%

Successful Treatment of a COVID-19 Patient with Fulminant Myocarditis: A Case Report and Review of Literature

Wang¹,

Wang²,

Song³

2022

IJCEMR

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“…Based on our study, all of the above-mentioned features, including young age, absence of cardiovascular risk factors, history of fever or any other infection symptoms, atypical troponin release, and an increased CRP level on admission may compose a low-risk MI patient's profile. Until now, there have been few studies sufficiently differentiating myocarditis and MI on the grounds of the non-invasive tests [9,13,17,33]. They have recommended assessment of the MI risk among young patients with ST-segment elevation before the invasive procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The actual and accurate incidence of myocarditis in populations remains unknown, as the endomyocardial biopsy (EMB)-the diagnostic ESC gold standard-is infrequently followed in clinical practise [11,12]. It 2 of 12 is estimated that myocarditis may show the global annual prevalence of approximately 22 people for every 100,000 [13]. It is still considered a poorly understood inflammatory disease of heterogeneous manifestation caused by a variety of factors, such as infections, systemic diseases, drugs, and toxins [11,14,15].…”

Section: Introductionmentioning

confidence: 99%

Symptomatic Young Adults with ST-Segment Elevation—Acute Coronary Syndrome or Myocarditis: The Three-Factor Diagnostic Model

Wieczorkiewicz

Przybylak

Supel

et al. 2022

JCM

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Myocarditis may mimic myocardial infarction (MI) due to a similar clinical presentation, including chest pain, electrocardiography changes, and laboratory findings. The purpose of the study was to investigate the diagnostic value of clinical, laboratory, and electrocardiography characteristics of patients with acute coronary syndrome - like myocarditis and MI. We analysed 90 patients (≤45 years old) with an initial diagnosis of ST-segment elevation myocardial infarction; 40 patients (44.4%), through the use of cardiac magnetic resonance, were confirmed to have myocarditis, and 50 patients (55.6%) were diagnosed with MI. Patients with myocarditis were younger and had fewer cardiovascular risk factors than those with MI. The cutoff value distinguishing between myocarditis and MI was defined as the age of 36 years. The history of recent infections (82.5% vs. 6%) and C-reactive protein (CRP) levels on admission (Me 45.9 vs. 3.4) was more associated with myocarditis. Further, the QTc interval was inversely correlated with the echocardiographic ejection fraction in both groups but was significantly longer in patients with MI. Non-invasive diagnostics based on clinical features and laboratory findings are basic but still essential tools for differentiation between MI and myocarditis. The three-factor model including the criteria of age, abnormal CRP, and history of recent infections might become a valuable clinical indication.

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“…Viral myocarditis is often misdiagnosed as CHD in clinical practice. In 2019, Mosebach et al reported a case of acute myocarditis presenting as an acute coronary syndrome [ 7 ]. In 2020, Tran et al studied a case of idiopathic eosinophilic myocarditis presenting with features of an acute coronary syndrome [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock Induced by Anterior Pituitary Hypofunction and Thyrotoxicosis

Li¹,

Li²,

Gao³

et al. 2020

Cureus

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Cardiogenic shock occurs when the heart is unable to pump enough blood for the needs of the body. Hypopituitarism is a condition in which the pituitary gland does not produce enough of one or more hormones, and it rarely occurs with thyrotoxicosis. We report a rare case of cardiogenic shock induced by anterior pituitary hypofunction and thyrotoxicosis. A 47-year-old woman was admitted twice to the hospital due to generalized worsening muscle pain for 13 days, and accompanied by a transient loss of consciousness. Cardiogenic shock developed during hospitalization, which improved with active resuscitative measures. Laboratory tests showed thyrotoxicosis. Pituitary magnetic resonance imaging (MRI) and relevant hormone tests confirmed anterior pituitary hypofunction. The patient was given hormone replacement therapy, which stabilized her condition. We believe cardiogenic shock may be a serious complication of hypopituitarism. We recommend establishing an expert system (ES) to facilitate the early diagnosis and treatment of cardiogenic shock, improve the professional skills of primary care physicians, and optimize treatment plans.

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Acute Myocarditis Presenting as Acute Coronary Syndrome

Cited by 4 publications

References 7 publications

Successful Treatment of a COVID-19 Patient with Fulminant Myocarditis: A Case Report and Review of Literature

Successful Treatment of a COVID-19 Patient with Fulminant Myocarditis: A Case Report and Review of Literature

Symptomatic Young Adults with ST-Segment Elevation—Acute Coronary Syndrome or Myocarditis: The Three-Factor Diagnostic Model

Cardiogenic Shock Induced by Anterior Pituitary Hypofunction and Thyrotoxicosis

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