Journal of Emergency Practice and Trauma

An acute ST-elevation myocardial infarction which went viral

Document Type : Case Report

Authors

Chui King Wong 1
Glen Chiang Hong Tan 2
Mohd Johar Jaafar 3

1 Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia

2 Department of Emergency Medicine, Hospital Tengku Ampuan Rahimah, Jalan Langat, 41200 Klang, Selangor Darul Ehsan, Malaysia

3 1Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia

https://doi.org/10.34172/jept.2021.27
Abstract
Objective: ST-elevations in electrocardiogram (ECG) secondary to an acute myocarditis may mimic ST-elevation myocardial infarction (STEMI). It is vital to distinguish between the two entities to avoid inappropriate clinical management and complications.
Case Presentation: A previously well 19-year-old male presented with two episodes of central chest pain which were resolved spontaneously. His presentation was preceded by multiple episodes of vomiting, diarrhoea and abdominal pain. Physical examination was unremarkable except for a low-grade temperature of 37.7°C. The first ECG revealed ST-segment elevations in anterior leads without reciprocal changes. Serial ECGs showed increasing ST elevations and his cardiac markers were significantly raised. As the initial clinical presentation was potentially an acute coronary syndrome, he was instinctively treated with anti-platelets. Fortunately, this patient was not given thrombolysis as there were clinical suspicions of an acute myocarditis due to his young age, presence of viral symptoms, and absence of cardiac risk factors. Subsequent cardiac MRI confirmed the diagnosis of an acute myocarditis.
Conclusion: An acute myocarditis is well known but less common presentation of viral infections. ST-segment elevations in ECG of any young patients with chest pain but without risk factors for acute coronary syndrome should always raise the suspicion of acute myocarditis especially in the presence of viral symptoms. Investigations such as cardiac magnetic resonance imaging (MRI) should be carried out emergently to distinguish both conditions.

Keywords

Myocarditis
ST Elevation Myocardial Infarction
Viral infections
Subjects
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Journal of Emergency Practice and Trauma
Volume 8, Issue 1
January 2022
Pages 74-76

  • Receive Date 06 September 2021
  • Revise Date 05 November 2021
  • Accept Date 18 November 2021

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