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CR 10 : Myocarditis mimicking an acute coronary syndrome. Contribution of cardiac MRI

CR 10 : Myocarditis mimicking an acute coronary syndrome. Contribution of cardiac MRI. Sdiri W., Mbarek D., Tlili R., Ben Ameur Y., Boujnah M. R. Cardiology Departement – Mongi Slim University Hospital La Marsa – TUNISIA. Background.

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CR 10 : Myocarditis mimicking an acute coronary syndrome. Contribution of cardiac MRI

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  1. CR 10: Myocarditis mimicking an acute coronary syndrome. Contribution of cardiac MRI Sdiri W., Mbarek D., Tlili R., Ben Ameur Y., Boujnah M. R. Cardiology Departement – Mongi Slim University Hospital La Marsa – TUNISIA

  2. Background • Myocarditis is an inflammation of myocardium usually due to a viral infection. • Clinical presentation: Heart failure + Fever • Rarely: chest pain mimicking acute coronary syndromes.

  3. Case report • A 42 years-old man. • CV risk factors: smoking • Admitted to our CCU for prolonged chest pain. • Physical exam: • Temperature:37.2°C • Blood pressure: 14/9 • Cardiac auscultation: nomal • No cardiacfailure.

  4. ECG Electrocardiogram showed neither Q waves, nor repolarization abnormalities.

  5. Chest X-Ray

  6. Biology • White bloodcells=11.000el/mm3 • Hb= 16.4g/dl • Creatinin=63µmol/l • Troponin=1.44ng/l Positive • CPK=348UI/l

  7. Echocardiography • LVd=48mm • LVs=30mm • EF=61% • No abnormal wall motion

  8. The diagnosis of Non ST Segment Elevation acute coronary syndrome was considered. • The patient received anti-ischemic treatment. • Coronary angiogram: normal. An acute myocarditis was suspected.

  9. Cardiac MRI RV LV Short axis view: subepicardiallateenhacementinvolving the antero-septal wall

  10. The diagnosis of myocarditis was finally retained. • The anti-ischemic treatment was stopped. • After 6-month follow-up, the patient is still asymptomatic.

  11. Conclusion: • Cardiac MRI is the gold standard for detecting myocardial infarction (subendocardial or transmuralenhacement). • It also allows easily the diagnosis of myocarditis (subepicardial late enhacement). • In a context of acute chest pain, Cardiac MRI should be performed if ECG, echocardiogram or coronary angiogram are not conclusive.

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