Basart Lazaro, Diaz Oscar, Bhandal Jasmandeep, Mohana Montadar, Sande Kevin, Razzeto Mariano
Internal Medicine, Palmetto General Hospital, Hialeah, USA.
Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.
Cureus. 2025 Jul 3;17(7):e87226. doi: 10.7759/cureus.87226. eCollection 2025 Jul.
Myopericarditis is an inflammatory cardiac condition that can closely mimic ST-elevation myocardial infarction (STEMI), presenting with chest pain, elevated troponin levels, and ST-segment changes on electrocardiogram (ECG). We present the case of a 46-year-old man with a history of hypertension who presented to the emergency department with sudden-onset, substernal chest pain that awoke him from sleep. The pain was described as crushing in nature, associated with diaphoresis, and was initially attributed to anxiety. Electrocardiography revealed ST-segment elevations in leads II, III, and aVF, with reciprocal changes and an incomplete right bundle branch block (IRBBB). Initial troponin I was markedly elevated at 16.9 ng/mL. Given these concerning findings, the patient underwent emergent cardiac catheterization. Coronary angiography revealed no obstructive coronary artery disease, and left ventriculography demonstrated preserved systolic function. Further evaluation uncovered a recent viral upper respiratory infection, and transthoracic echocardiography showed diastolic dysfunction with a trivial pericardial effusion. The combination of clinical presentation, elevated cardiac markers, ST-segment changes, and absence of coronary pathology led to the diagnosis of myopericarditis. This case highlights the importance of maintaining a broad differential diagnosis in patients presenting with apparent acute coronary syndromes and underscores the need for comprehensive assessment to avoid unnecessary interventions.
心肌心包炎是一种炎症性心脏疾病，可酷似ST段抬高型心肌梗死（STEMI），表现为胸痛、肌钙蛋白水平升高以及心电图（ECG）上的ST段改变。我们报告一例46岁男性病例，该患者有高血压病史，因突发胸骨后胸痛从睡眠中惊醒而就诊于急诊科。疼痛性质为压榨性，伴有出汗，最初被归因于焦虑。心电图显示II、III和aVF导联ST段抬高，伴有对应性改变和不完全性右束支传导阻滞（IRBBB）。初始肌钙蛋白I显著升高，达16.9 ng/mL。鉴于这些令人担忧的发现，患者接受了紧急心脏导管插入术。冠状动脉造影显示无阻塞性冠状动脉疾病，左心室造影显示收缩功能正常。进一步评估发现近期有病毒性上呼吸道感染，经胸超声心动图显示舒张功能障碍伴微量心包积液。临床表现、心脏标志物升高、ST段改变以及无冠状动脉病变相结合，最终诊断为心肌心包炎。该病例强调了对表现为明显急性冠状动脉综合征的患者进行广泛鉴别诊断的重要性，并强调了进行全面评估以避免不必要干预的必要性。
