The role of cardiovascular magnetic resonance in the evaluation of chest pain etiology: a case report.

In the evaluation of patients with chest pain it is crucial to differentiate between cardiac and non-cardiac etiology. In turn, acute chest pain of cardiac origin includes many clinical entities. The combination of elevated cardiac serum markers, particularly troponin, with typical clinical presentation and electrocardiographic abnormalities most frequently establishes a diagnosis of acute coronary syndrome. However, when coronary angiography reveals only non-significant lesions, this may present a diagnostic dilemma. The authors present the case of a patient admitted with chest pain, initially interpreted as an acute coronary syndrome, based on laboratory parameters and electrocardiographic abnormalities. Coronary angiography showed normal coronary arteries. This result, combined with the findings of subsequent cardiovascular magnetic resonance (myocardial edema and subepicardial delayed enhancement), established a diagnosis of myocarditis. The case illustrates the application of this noninvasive imaging technique in the diagnostic work-up of patients with acute chest pain.