Acute Crit Care.  2022 May;37(2):258-262. 10.4266/acc.2021.00290.

Acute perimyocarditis mimicking acute myocardial infarction in a 12-year-old boy with duchenne muscular dystrophy

• Choi HJ
• Kwon HW
• Oh KJ
• Song MK

• KMID: 2531685
• DOI: http://doi.org/10.4266/acc.2021.00290

Abstract

Differential diagnosis of chest pain in the pediatric population is important but can be challenging. A 12-year-old boy with Duchenne muscular dystrophy presented with chest pain, cardiac enzyme elevation, and convex ST elevations in the inferior leads with reciprocal ST depression in the anterior leads on electrocardiogram. Echocardiography on admission revealed normal left ventricular function. Suspecting acute myocardial infarction, we performed invasive coronary angiography, which revealed normal coronary arteries. A follow-up electrocardiogram showed an acute pericarditis pattern with concave ST elevations in most leads and PR depression, and follow-up echocardiography revealed global left ventricular dysfunction, suggestive of acute perimyocarditis. Ibuprofen was administered for acute pericarditis, and a continuous milrinone infusion was commenced for myocardial dysfunction. The chest pain improved by the next day, and the ST segment elevations normalized on day 4. Echocardiography on day 9 revealed improved left ventricular function. The patient was discharged on day 11, and he is doing well without chest pain through 12 months of follow-up. The last electrocardiogram showed normal sinus rhythm without ST change. Differential diagnosis of acute myocardial infarction and acute perimyocarditis is important for proper treatment strategies and the different prognoses of these two conditions.

Keyword

Case report; Myocarditis; Pericarditis; ST elevation myocardial infarction

Figure

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  Figure 1. (A) Initial chest radiograph showing no cardiothoracic abnormalities. (B) Echocardiography performed on the second day of hospitalization showing mild global left ventricular dysfunction (ejection fraction, 41%) without regional wall motion abnormalities. (C, D) Cardiac magnetic resonance imaging showing late gadolinium enhancement (arrowheads) in the subepicardium of the left ventricular inferolateral and mid-septal walls.

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  Figure 2. (A) Initial electrocardiogram showing ST elevations in the inferior leads and reciprocal ST depressions in the anterior leads. (B) Electrocardiogram, 3 hours post-admission, showing aggravated convex ST elevations and reciprocal changes. (C) Electrocardiogram, 12 hours post-admission, showing concave ST elevations in most leads and PR depression. (D) ST segment elevations normalized on the 4th day of hospitalization after ibuprofen treatment. aVR: lead augmented vector right; aVL: lead augmented vector left; aVF: lead augmented vector foot.

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