Myocarditis or Acute Coronary Syndrome?
It is well known that acute myocarditis can clinically masquerade as acute MI. In the setting of acute chest pain with concomitant ST-segment elevation on at least two contiguous ECG leads, guidelines for therapeutic management of ST-segment elevation MI should be applied.
We suggest that invasive coronary angiography should be the preferred method when rapidly available in order to avoid inappropriate thrombolytic therapy. CMR should play an important role when coronary angiography rules out significant coronary stenosis in these cases and has the potential to confirm the diagnosis of myocarditis. On the other hand, in the setting of acute chest pain without ST-segment elevation, CMR if rapidly available may become the first line imaging study, especially in those patients with low risk profile and/or recent history of flu.Myocardial edema may be depicted on T2-weighted black-blood spin echo CMR during the acute phase of MI. Although myocardial distribution of edema is theoretically different, it is often difficult to distinguish between myocarditis and acute MI based on T2-weighted CMR images. First- pass myocardial perfusion imaging may help distinguish the two diseases as there is no early subendocardial defect in myocarditis, whereas it is very common in acute MI despite prompt reopening of the infarct- related-artery (60% of cases). As previously described, patterns of delayed hyperenhancement are very distinct and the most useful to discriminate between acute MI and acute myocarditis (Table 1).
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- Barbaro Giuseppe, Boccara Franc (eds.). Cardiovascular Disease in AIDS. 2nd edition. — Springer,2009. — 169 p., 2009