Fernando Ashen, Guragai Nirmal, Vasudev Rahul, Pullatt Raja, Randhawa Preet
Cardiology, St. George's University School of Medicine, True Blue, GRD.
Cardiology, Saint Joseph's University Medical Center, Paterson, USA.
Cureus. 2020 Nov 24;12(11):e11671. doi: 10.7759/cureus.11671.
Myocarditis is caused by acute injury and inflammation of cardiac myocytes and is most commonly caused by a viral infection. Myocarditis remains a rare diagnosis and manifests with a wide spectrum of non-specific symptoms that include chest pain, dyspnea, and palpitations associated with electrocardiographic abnormalities that resemble that of ST-elevation myocardial infarction (STEMI). Therefore, clinical diagnosis is often challenging and is often misdiagnosed. We present a case of a 22-year-old male who presented with left-sided non-radiating chest pain associated with shortness of breath, elevated troponin of 3.2 ng/ml (<0.03 ng/ml). Electrocardiogram (ECG) and cardiac echocardiogram revealed ST-segment elevations in the anterolateral leads and an ejection fraction of 35%, respectively. The patient was initially suspected of having a STEMI; however, cardiac catheterization revealed non-obstructed coronary arteries. Due to elevated inflammatory markers, the patient was then started on colchicine for suspected myocarditis and had complete resolution of symptoms one week after. This case highlights that a high index of clinical suspicion and prompt diagnosis is necessary to prevent any delays in appropriate therapy for myocarditis.
心肌炎是由心肌细胞的急性损伤和炎症引起的，最常见的病因是病毒感染。心肌炎仍然是一种罕见的诊断，表现为广泛的非特异性症状，包括胸痛、呼吸困难和心悸，伴有类似于ST段抬高型心肌梗死（STEMI）的心电图异常。因此，临床诊断往往具有挑战性，且经常被误诊。我们报告一例22岁男性患者，其表现为左侧非放射性胸痛伴呼吸急促，肌钙蛋白升高至3.2 ng/ml（<0.03 ng/ml）。心电图（ECG）和心脏超声心动图分别显示前外侧导联ST段抬高和射血分数为35%。该患者最初被怀疑患有STEMI；然而，心脏导管检查显示冠状动脉无阻塞。由于炎症标志物升高，该患者随后因疑似心肌炎开始服用秋水仙碱，一周后症状完全缓解。该病例强调，对于心肌炎，高度的临床怀疑和及时诊断对于防止适当治疗的任何延迟是必要的。
