Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Myocarditis presenting as typical acute myocardial infarction: A case report and review of the literature
Ya-Min Hou, Peng-Xi Han, Xia Wu, Jing-Ru Lin, Fei Zheng, Lin Lin, Rui Xu
Ya-Min Hou, Xia Wu, Lin Lin, Rui Xu, Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong Province, China
Peng-Xi Han, Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong Province, China
Jing-Ru Lin, Department of Cardiology, Shandong Provincial Third Hospital, Jinan 250014, Shandong Province, China
Fei Zheng, Rui Xu, Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong Province, China
Author contributions: Hou YM, Lin JR, Wu X, Zheng F, Han PX, and Lin L were involved in diagnostic flow and patient follow-up; Hou YM contributed to interpretation of published data and drafting the manuscript; Xu R revised the manuscript; all the authors read and gave their final approval of the version to be published.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rui Xu, MD, PHD, Chief Physician, Professor, Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University; Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766, Jingshi Road, Jinan 250014, Shandong Province, China. xuruicn@hotmail.com
Received: September 19, 2019
Peer-review started: September 19, 2019
First decision: December 4, 2019
Revised: December 17, 2019
Accepted: December 22, 2019
Article in press: December 22, 2019
Published online: January 26, 2020
BACKGROUND
Myocarditis refers to a variety of myocardial inflammatory lesions. A variety of factors such as infection and physical and chemical factors can cause myocarditis. Depending on the severity of myocardial damage, myocarditis patients can manifest heart failure, cardiogenic shock, and even sudden death. Here we present a case of viral myocarditis that mimicked acute coronary syndrome.
CASE SUMMARY
A middle-aged male patient presented with chest pain and elevated troponin I after a flu-like infection. This patient had a history of hypertension and a habit of alcohol and tobacco use. Electrocardiography showed typical changes in acute myocardial infarction, with the T-wave increasing. Coronary angiogram revealed no stenosis. Cardiac magnetic resonance imaging revealed edema of the middle and apical septal and apical anterior walls on T2-weighted images and the T1 mapping. Late gadolinium enhancement of the middle and apical septal and apical anterior walls could be found. Rubella virus immunoglobulin G and immunoglobulin M antibodies were abnormally elevated. The patient was given antiviral and antibiotic treatments, and serum biomarkers and electrocardiograph returned to normal after 5 d of treatment. After one-year follow-up, the patient showed no symptoms, and cardiac magnetic resonance showed that myocardial thickness was significantly thinner than before, and fibrosis was less than before.
CONCLUSION
This case illustrates the utility of cardiac magnetic resonance for diagnosis of infarction-like myocarditis when the angiogram is normal.
Core tip: We present a case of myocarditis with typical acute myocardial infarction symptoms. The diagnosis was confirmed by cardiac magnetic resonance. We followed the patients up to 13 mo, and performed three times of cardiac magnetic resonance. We observed the changes of the myocardial edema and the area of enhancement. We also discuss myocarditis that mimics acute myocardial infraction in order to help clinicians improve their diagnosis and treatment skills.
