Electrocardiographic changes in acute perimyocarditis

Abstract

Pericarditis and myocarditis are characterised by electrocardiographic changes and elevated cardiac enzymes, respectively, and patients with perimyocarditis often complain of chest discomfort. These findings are nonspecific and often lead to diagnostic difficulties, as ST-elevation myocardial infarction commonly presents in a similar fashion. Clinical differentiation between perimyocarditis and myocardial infarction are especially important because adverse side effects can occur if reperfusion therapy is administered for a patient with acute pericarditis or if a diagnosis of acute myocardial infarction is missed. We herein describe a case of perimyocarditis with ST elevation and raised cardiac markers, which led to two emergency coronary angiographies that were subsequently found to be normal. We include the three serial electrocardiographies (ECGs) performed to show the characteristic features of perimyocarditis and further discuss the importance of identifying typical and atypical ECG features of pericarditis.

Takotsubo cardiomyopathy associated with perimyocarditis: yet another important differential diagnosis to entertain

“…(5 ) Furthermore, in Lee et al's report, (1) the presence of apical hypokinesis, in addition to a midinferoseptal hypokinesia, may highly support our hypothesis of atypical TC superimposed on the preceding perimyocarditis. Did the authors perform a repeat echocardiography to observe any improvement in wall function?…”

“…(4) The preceding myopericarditis can thus serve as a stressor substrate for TC. Thus, we wonder if Lee et al's (1) fi nding from the second ECG can be better explained by TC or diffuse epicardial coronary vasospasm (one of the potential pathophysiological mechanisms for TC). The electrocardiographic evolution of TC is very similar to the four-stage evolution of pericarditis.…”

“…We read with great interest the report by Lee et al, (1) who did a commendable job of illustrating the clinical pearls in perimyocarditis and emphasised the importance of recognising its electrocardiographic evolution/staging. However, we would like to point out an additional important diagnostic electrocardiographic marker.…”

“…In the fi rst electrocardiogram (ECG) of Lee et al's report, (1) downsloping of TP segments, known as Spodick's sign, (2) which is named after the pioneer work of our former university professor Dr David Spodick, is observed. This fi nding is best noted in lead II and the lateral precordial leads, and is present in about 80% of cases of acute pericarditis (Fig.…”

Differentiation between myopericarditis and acute myocardial infarction on presentation in the emergency department using the admission C-reactive protein to troponin ratio

“…It is frequently difficult to differentiate on clinical grounds between myopericarditis and acute myocardial infarction (AMI) as the cause of an acute cardiac event [1] since both conditions present with acute chest pain, electrocardiographic changes and elevated troponin level [2,3]. Occasionally, myopericarditis may mimic AMI and present acutely with typical ischemic symptoms, while the electrocardiogram may demonstrate ischemic changes or even simulate an ST-segment elevation myocardial infarction (STEMI).…”