1. CR 10: Myocarditis mimicking an acute coronary syndrome
CR 10: Myocarditis mimicking an acute coronary syndrome. Contribution of cardiac MRI
Sdiri W., Mbarek D., Tlili R., Ben Ameur Y., Boujnah M. R.
Cardiology Departement – Mongi Slim University Hospital
La Marsa – TUNISIA

2. Background
Myocarditis is an inflammation of myocardium usually due to a viral infection.
Clinical presentation: Heart failure + Fever
Rarely: chest pain mimicking acute coronary syndromes.

3. Case report A 42 years-old man. CV risk factors: smoking
Admitted to our CCU for prolonged chest pain.
Physical exam:
Temperature:37.2°C
Blood pressure: 14/9
Cardiac auscultation: nomal
No cardiac failure.

4. ECG
Electrocardiogram showed neither Q waves, nor repolarization abnormalities.

5. Chest X-Ray

6. Biology Troponin=1.44ng/l Positive White blood cells=11.000el/mm3
Hb= 16.4g/dl
Creatinin=63µmol/l
Troponin=1.44ng/l Positive
CPK=348UI/l

7. Echocardiography
LVd=48mm
LVs=30mm
EF=61%
No abnormal wall motion

8. Coronary angiogram: normal.
The diagnosis of Non ST Segment Elevation acute coronary syndrome was considered.
The patient received anti-ischemic treatment.
Coronary angiogram: normal.
An acute myocarditis was suspected.

9. Cardiac MRI RV LV
Short axis view: subepicardial late enhacement involving the antero-septal wall

10. The diagnosis of myocarditis was finally retained.
The anti-ischemic treatment was stopped.
After 6-month follow-up, the patient is still asymptomatic.

11. Conclusion:
Cardiac MRI is the gold standard for detecting myocardial infarction (subendocardial or transmural enhacement).
It also allows easily the diagnosis of myocarditis (subepicardial late enhacement).
In a context of acute chest pain, Cardiac MRI should be performed if ECG, echocardiogram or coronary angiogram are not conclusive.