Brief report: recognition of acute myocarditis masquerading as acute myocardial infarction

Article Abstract:

Patients exhibiting symptoms of a heart attack but with normal heart arteries may have acute myocarditis. Both myocarditis and heart attacks are associated with severe chest pain, abnormal electrocardiograph readings and increased levels of creatine kinase. Eight people with sudden, prolonged chest pain were initially diagnosed with a heart attack, but angiography revealed normal heart arteries. Suspected myocarditis was confirmed in all eight patients using endomyocardial biopsy and antimyosin antibody scintigraphy, and the results were compared with antimyosin scans from 45 heart attack patients. Uptake of the antimyosin antibody in the patients with myocarditis was diffuse and global compared with the intense, localized uptake seen in the heart attack patients. Endomyocardial biopsy is the conventional method of diagnosing myocarditis, but these findings show antimyosin scintigraphy, a simpler procedure than a biopsy, can be useful.

Diagnosis, Myocarditis, Radionuclide imaging, Radioisotope scanning

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A 68-year-old man with acute mitral regurgitation

Article Abstract:

A 68-year-old man was diagnosed with mitral valve insufficiency following a heart attack. The patient was transferred to the hospital with a fever, fluid in his lungs, low blood pressure and decreased urination. He had had a heart attack approximately two weeks earlier, and had been admitted to another hospital. He had been treated with drugs to prevent another heart attack at the other hospital, but his symptoms had persisted. He smoked heavily, and drank three to four bottles of beer every day. He had high blood levels of cholesterol. A series of angiograms revealed coronary artery disease, with blockage of the right coronary artery by a blood clot. One of the muscles attached to one of the heart valves was ruptured. He underwent catheterization of his heart, and surgery to replace his mitral valve. He was transferred to the intensive care unit to recover.

Coronary heart disease, Heart attack, Mitral valve insufficiency

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Wide-complex tachycardia in a 65-year-old woman without previous evidence of cardiac disease

Article Abstract:

A 65-year-old woman was diagnosed with a hereditary true aneurysm of the left ventricle of the heart. She was admitted to the hospital with ventricular tachycardia, an abnormally fast heart rate, after several days of vomiting and diarrhea. A spin-echo magnetic resonance imaging scan, a coronary arteriogram and a biplane left ventriculogram revealed an aneurysm in the left ventricle of the heart. An echocardiogram of left ventricular function did not determine conclusively whether the patient had a true or pseudoaneurysm. The aneurysm was found to be a true aneurysm during surgery, and was removed. The patient recovered and remained healthy seven months after the operation.

Ventricular tachycardia, Ventricular aneurysms, Ventricular aneurysm

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