Talard P, Bouchiat C, Bonal J, Houplon P, Vahdat B, Dussarat G V
Service de Cardiologie, HIA Sainte-Anne, Toulon Naval.
Ann Cardiol Angeiol (Paris). 1993 Oct;42(8):419-26.
The authors report two cases of myocarditis in young individuals in whom clinical and electrocardiographic findings during the acute phase could have led to an erroneous diagnosis of myocardial infarction. The problem in such cases is that of a differential diagnosis with infarction with normal coronary arteries. Few clinical or paraclinical arguments are of diagnostic value, endomyocardial biopsy remaining the reference investigation. Proof of viral infection is not always obtained. It is often the retrospective argument of "complete return to normal" which supports the clinical impression. This usual benign outcome is not always the case, since cases of cardiogenic shock have been reported. The dual nature of the pathogenesis ("myositis" and/or "vasculitis" with thrombus and actual MI) is stressed.
作者报告了两例年轻患者的心肌炎病例，其急性期的临床和心电图表现可能导致对心肌梗死的误诊。此类病例的问题在于与冠状动脉正常的梗死进行鉴别诊断。很少有临床或辅助临床证据具有诊断价值，心内膜心肌活检仍是参考性检查。并非总能获得病毒感染的证据。往往是“完全恢复正常”这一回顾性论据支持临床诊断。这种常见的良性结局并非总是如此，因为已有心源性休克病例的报道。强调了发病机制的双重性质（“肌炎”和/或“血管炎”伴血栓形成及实际心肌梗死）。
