Myopericarditis: under a mask of acute coronary syndrome

The aim of the study was to evaluate the prevalence rate, clinical features and outcomes of myopericarditis in patients, hospitalized with initial diagnosis of ST-elevation Acute Coronary Syndrome (ACS). Methods: 634 pts with ST-elevation ACS were included. They underwent emergency Coronary Angiography (CAG), ECG, echo and laboratory testing (cardiac troponin level, inflammatory markers). Contrast-enhanced Magnetic Resonance Imaging (MRI) was used to verify the diagnosis of myopericarditis. Results: Among 634 pts with typical clinical characteristics of ACS, elevated troponin and persistent ST-elevation on ECG, myopericarditis was diagnosed in 4 cases (0.6%), mean age 27.5±5.2 yrs, all were males. Presumable etiology remained unknown, but 2 patients recently had viral infection and one patient underwent toxic effect of hydrogen sulphide before admission. All of them had intensive chest pain and exertional dyspnea, 3 patients experienced shortness of breath and dizziness at rest. In two patients the course of acute myopericarditis was complicated by pulmonary edema. Other complaints included arrhythmia (25%), pre-syncope (25%) and low-grade fever (75%). ST-elevation on ECG was predominantly localized in inferior (75%) and lateral leads (25%). Three patients had inferolateral wall hypokinesis during echocardiography, other parameters (heart size, global contractility and pulmonary artery systolic pressure) were normal. Mean EF was 53.7±7.2%. All patients diagnosed with acute myopericarditis received anti-inflammatory drugs, diuretics and symptomatic treatment and remained hemodinamically stable in hospital period. During 12-month follow up period after acute myopericarditis we didn't register fatal outcomes or major adverse cardiovascular events. Conclusions: The difficulty in diagnostics of inflammatory myocardial diseases lies in the poor specificity and sensitivity of the various diagnostic techniques used. Our report illustrates that patients with suspected acute myocardial infarction but normal coronary angiography may have likely myocarditis. Confusing factors are typical angina, elevated cardiac troponin level and ST-segment elevation on ECG, suggestive of acute myocardial infarction. Pathogenetic anti-inflammatory treatment contributed to considerable improvement of the clinical and functional status of patients.