Ewha Med J.  2012 Sep;35(2):129-134. 10.12771/emj.2012.35.2.129.

Phantom Ischemia Mimicking ST Segment Elevation Myocardial Infarction in Fulminant Myocarditis

• Kim SH
• Kim YH
• Lee JS
• Hwang YJ
• Lee JM
• Kang K
• Song WH
• Ahn JC

• KMID: 2284005
• DOI: http://doi.org/10.12771/emj.2012.35.2.129

Abstract

A 30-year-old man visited the emergency room for chest pain, dyspnea and fever. Despite increased serum cardiac enzymes, ST segment elevation and inferior wall akinesis in electrocardiography and echocardiography, no atherosclerosis was evident in the coronary angiography. However, radionuclide myocardial perfusion image at day 2 showed a persistent perfusion defect in the left ventricular (LV) inferior wall. At day 3, prominent myocardial edema and severe LV systolic dysfunction developed with signs of heart failure. In this case, fulminant myocarditis seemed to originate from the right coronary artery territory and simulated a ST segment elevation myocardial infarction without coronary artery obstruction. The pathogenesis of the localized perfusion defect was unlcear.

Keyword

Coronary artery vasospasm; Myocardial infarction; Myocardial perfusion image; Myocarditis

MeSH Terms

Atherosclerosis
Chest Pain
Coronary Angiography
Coronary Vasospasm
Coronary Vessels
Dyspnea
Echocardiography
Edema
Electrocardiography
Emergencies
Fever
Heart Failure
Ischemia
Myocardial Infarction
Myocarditis
Perfusion

Figure

• 

  Fig. 1 Electrocardiography and coronary angiography data. Q waves and ST segment elevation are indicated by arrows (A). Coronary angiography shows normal coronary arteries (B, C).

• 

  Fig. 2 Bedside two-dimensional echocardiography in emergency room showing akinesis at basal to mid left ventricular inferior segments. (A) Parasternal short axis image. (B) Apical two chamber image (Video clip of this figure is available at http://emj.ewhamed.ac.kr/journal/view.html?Vol=035&Num=02&page=129).

• 

  Fig. 3 Radionuclide myocardial perfusion image. (A) Perfusion defect in basal to mid inferior left ventricular segment is noted at day 2. (B) Perfusion defect disappears in 2 weeks.

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  Fig. 4 Two-dimensional echocardiography at day 2 showing diffuse hypokinesis of left ventricle with severe systolic dysfunction. Mild pericardial effusion is noted. (A) Parasternal short axis image. (B) Apical two chamber image (Video clip of this figure is available at http://emj.ewhamed.ac.kr/journal/view.html?Vol=035&Num=02&page=129).

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