CR 10 Myocarditis mimicking an acute coronary syndrome

CR 10: Myocarditis mimicking an acute coronary syndrome. Contribution of cardiac MRI Sdiri W. , Mbarek D. , Tlili R. , Ben Ameur Y. , Boujnah M. R. Cardiology Departement – Mongi Slim University Hospital La Marsa – TUNISIA

Background • Myocarditis is an inflammation of myocardium usually due to a viral infection. • Clinical presentation: Heart failure + Fever • Rarely: chest pain mimicking acute coronary syndromes.

Case report • • A 42 years-old man. CV risk factors: smoking Admitted to our CCU for prolonged chest pain. Physical exam: ØTemperature: 37. 2°C ØBlood pressure: 14/9 ØCardiac auscultation: nomal ØNo cardiac failure.

ECG Electrocardiogram showed neither Q waves, nor repolarization abnormalities.

Chest X-Ray

Biology • White blood cells=11. 000 el/mm 3 • Hb= 16. 4 g/dl • Creatinin=63µmol/l • Troponin=1. 44 ng/l • CPK=348 UI/l Positive

Echocardiography • • LVd=48 mm LVs=30 mm EF=61% No abnormal wall motion

• The diagnosis of Non ST Segment Elevation acute coronary syndrome was considered. • The patient received anti-ischemic treatment. • Coronary angiogram: normal. An acute myocarditis was suspected.

Cardiac MRI RV LV Short axis view: subepicardial late enhacement involving the antero-septal wall

• The diagnosis of myocarditis was finally retained. • The anti-ischemic treatment was stopped. • After 6 -month follow-up, the patient is still asymptomatic.

Conclusion: • Cardiac MRI is the gold standard for detecting myocardial infarction (subendocardial or transmural enhacement). • It also allows easily the diagnosis of myocarditis (subepicardial late enhacement). • In a context of acute chest pain, Cardiac MRI should be performed if ECG, echocardiogram or coronary angiogram are not conclusive.