MYOCARDITIS MASQUERADING AS ACUTE CORONARY SYNDROME

Abstract

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Myocarditis is an inflammation of the myocardium, which may be caused by a variety of infectious or noninfectious conditions. The most common etiology is due to a viral infection secondary to coxsackie B virus, adenovirus, hepatitis C, cytomegalovirus (CMV), or influenza virus. The presentation of myocarditis is highly variable, ranging from heart failure, acute coronary syndrome and even sudden cardiac death. CASE PRESENTATION: This is the case of a 48-year-old man with history of hypertension, diabetes mellitus type 2, obstructive sleep apnea and history of multiple episodes of viral syndromes, who presented with retrosternal diffuse burning chest pain radiating to the neck and both shoulders. The pain had an intensity of 9 out of 10, with associated dyspnea on exertion, nausea and diaphoresis. Electrocardiogram revealed no ischemic changes, although there were positive cardiac markers. Subsequently, he was admitted to the Coronary Care Unit under the diagnosis of acute coronary syndrome without ST-segment elevation and underwent emergent catherization. Left heart catheterization revealed normal coronary arteries. Inflammatory marker was significant with a c-reactive protein level of 31.5mg/L. Cardiac MRI revealed dilated cardiomyopathy with severe systolic function and diffuse myocardial edema as may be seen in acute myocarditis. In view of the patient’s history of multiple episodes of viral syndromes, elevated inflammatory markers and findings evidenced on cardiac MRI, the most likely etiology was myocarditis secondary to viral infection. DISCUSSION: Viral myocarditis is a rare etiology consisting of 0.11% of all cases reported, however recurrent myocarditis may occur in approximately 11%. Treatment is mainly symptomatic. Supportive therapy for symptoms of acute heart failure with use of diuretics, nitroglycerin/nitroprusside, and angiotensin-converting enzyme (ACE) inhibitors. Chronic inflammation may cause dilated cardiomyopathy and subsequent heart failure. Patients with a history of myocarditis should be monitored at intervals of 1-3 months initially. CONCLUSIONS: Most patients with mild symptoms recover completely without any residual cardiac dysfunction, although a third subsequently develop dilated cardiomyopathy. Primary physicians must be aware of the diverse clinical manifestations of myocarditis, often, confused with acute myocardial infarction and how early identification can positively influence the patient’s outcome. Reference #1: https://emedicine.medscape.com/article/156330-overview Reference #2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814111/ Reference #3: https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.115.306573 DISCLOSURES: No relevant relationships by Francisco Tirado-Polo, source=Web Response