Nozari Younes, Tajdini Masih, Mehrani Mehdi, Ghaderpanah Rosa
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Emerg (Tehran). 2016 Summer;4(3):159-62.
Distinguishing ST-elevation myocardial infarction (STEMI) differential diagnoses is more challenging. Myopericarditis is one of these differentials that results from viral involvement of myocardium and pericardium of the heart. Myopericarditis in focal form can mimic acute STEMI in its electrocardiogram (ECG) features and elevated cardiac enzymes. Myocarditis patients may face thrombolytic related complications such as intracranial bleeding, myocardial rupture, and hemorrhagic cardiac tamponade. Furthermore, re-administration of streptokinase (a common thrombolytic agent in our country) is banned for at least six months of previous administration; however, it can save patients' lives in emergency conditions such as massive pulmonary embolism. It seems that, when dealing with a young patient presenting to emergency department with acute chest pain and ST segment elevation on ECG, we should consider focal myocarditis as an important but rare differential diagnosis of STEMI. In this report, we describe three cases of focal myocarditis, primarily misdiagnosed as STEMI.
鉴别ST段抬高型心肌梗死（STEMI）的鉴别诊断更具挑战性。心肌心包炎是这些鉴别诊断之一，它是由病毒累及心脏的心肌和心包引起的。局灶性心肌心包炎在心电图（ECG）特征和心肌酶升高方面可类似于急性STEMI。心肌炎患者可能面临与溶栓相关的并发症，如颅内出血、心肌破裂和出血性心脏压塞。此外，在我国，若之前至少已使用过六个月链激酶（一种常用溶栓剂），则禁止再次使用；然而，在诸如大面积肺栓塞等紧急情况下，它可挽救患者生命。似乎在处理一名因急性胸痛就诊于急诊科且心电图显示ST段抬高的年轻患者时，我们应将局灶性心肌炎视为STEMI的一种重要但罕见的鉴别诊断。在本报告中，我们描述了三例最初被误诊为STEMI的局灶性心肌炎病例。
