Localized ST Elevation in ECG: Acute Myopericarditis Mimicking ST Elevation Myocardial Infarction
Author : T. N. P. Adityaputra, L. O. S. Suastika
Upload Date : 19-04-2018
Myocarditis is the inflammation of myocardium as a result of infection, autoimmune disease or cardiotoxic agents. Clinical manifestations of myocarditis vary widely from asymptomatic to resembling acute coronary syndrome or cardiogenic shock. Myocarditis may be accompanied by pericarditis. Our patient is a 24 years-old male who was referred from a private hospital with anterior ST Elevation Myocardial Infarction (STEMI) and already treated with loading dose of dual antiplatelet therapy. He had typical chest pain radiating to left arm since eight hours prior to admission. He also complained of fever and acute diarrhea 5-6 times since one day before. He had no history of smoking, alcohol consumption or metabolic diseases. Physical examination was within normal limit, except that he was overweight. There was ST-segment elevation in the V2-V6 on ECG. Cardiac and inflammatory markers were all increased (CK-MB mass 71.2 ng/mL, troponin-I 29,799 ug/L, myoglobin 251 ug/L, CRP 57.34 mg/L). Echocardiography showed normal left ventricular systolic function and wall motion. The initial assessment was anterior STEMI with differential diagnosis of acute myopericarditis. He underwent coronary angiography which showed normal coronary arteries. We finally diagnosed him as acute myopericarditis that might be caused by viral infection due to acute diarrhea. We treated the patient with ibuprofen 600 mg every 8 hours for 7 days continued with 200 mg every 8 hours for the next 7 days. He was later followed up at the outpatient clinic without any complaint and ECG showed sinus rhythm with T inversion in the V4-V6 (all ST elevation had resolved). This case showed that myopericarditis can resemble signs and symptoms of STEMI, especially when it presented with typical chest pain and localized ST segment elevation. Coronary angiography is required to determine whether there is coronary occlusion or stenosis.
KEYWORDS : myopericarditis, ST elevation myocardial infarction, coronary angiography.