Hou Ya-Min, Han Peng-Xi, Wu Xia, Lin Jing-Ru, Zheng Fei, Lin Lin, Xu Rui
Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong Province, China.
Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong Province, China.
World J Clin Cases. 2020 Jan 26;8(2):415-424. doi: 10.12998/wjcc.v8.i2.415.
Myocarditis refers to a variety of myocardial inflammatory lesions. A variety of factors such as infection and physical and chemical factors can cause myocarditis. Depending on the severity of myocardial damage, myocarditis patients can manifest heart failure, cardiogenic shock, and even sudden death. Here we present a case of viral myocarditis that mimicked acute coronary syndrome.
A middle-aged male patient presented with chest pain and elevated troponin I after a flu-like infection. This patient had a history of hypertension and a habit of alcohol and tobacco use. Electrocardiography showed typical changes in acute myocardial infarction, with the T-wave increasing. Coronary angiogram revealed no stenosis. Cardiac magnetic resonance imaging revealed edema of the middle and apical septal and apical anterior walls on T2-weighted images and the T1 mapping. Late gadolinium enhancement of the middle and apical septal and apical anterior walls could be found. Rubella virus immunoglobulin G and immunoglobulin M antibodies were abnormally elevated. The patient was given antiviral and antibiotic treatments, and serum biomarkers and electrocardiograph returned to normal after 5 d of treatment. After one-year follow-up, the patient showed no symptoms, and cardiac magnetic resonance showed that myocardial thickness was significantly thinner than before, and fibrosis was less than before.
This case illustrates the utility of cardiac magnetic resonance for diagnosis of infarction-like myocarditis when the angiogram is normal.
心肌炎是指多种心肌炎性病变。感染、理化因素等多种因素均可引起心肌炎。根据心肌损伤的严重程度，心肌炎患者可表现为心力衰竭、心源性休克，甚至猝死。在此，我们报告一例酷似急性冠状动脉综合征的病毒性心肌炎病例。
一名中年男性患者在流感样感染后出现胸痛和肌钙蛋白I升高。该患者有高血压病史，有烟酒习惯。心电图显示急性心肌梗死的典型变化，T波增高。冠状动脉造影未发现狭窄。心脏磁共振成像显示，在T2加权图像和T1映射上，室间隔中部和心尖以及心尖前壁出现水肿。可发现室间隔中部和心尖以及心尖前壁延迟钆增强。风疹病毒免疫球蛋白G和免疫球蛋白M抗体异常升高。给予患者抗病毒和抗生素治疗，治疗5天后血清生物标志物和心电图恢复正常。经过一年的随访，患者无症状，心脏磁共振显示心肌厚度比以前明显变薄，纤维化程度比以前减轻。
该病例说明了当血管造影正常时，心脏磁共振对梗死样心肌炎诊断的实用性。
