Acute myocarditis mimicking myocardial infarction can misdirect the diagnostic approach

Acute myocarditis is a well-recognized but rare manifestation of mostly viral infections. It can present with various clinical manifestations and may mimic myocardial infarction (MI) since patients usually present with chest pain, and the electrocardiographic changes similar to those observed in acute ST-elevation MI. We, herein, present such an extreme case of acute myocarditis characterized by dynamic ST segment elevation with reciprocal changes in the electrocardiogram.

ECG on admission revealed sinus rhythm and minimal ST-segment elevation in leads II, aVF, I, aVL, V5, and V6 with reciprocal ST segment depression at lead V1 (A). ECG taken when the patient had chest pain showed 4–5 mm ST-segment elevation in leads I, II, III, aVF, aVL, and V4–V6 with ST segment depression in right precordial leads. Posterior ECG showed that the ST-segment depression in right precordial leads was due to the reflection of ST elevation of the posterior wall (B). Coronary angiography showed normal epicardial coronary arteries (C). ECG on discharge revealed biphasic T waves in the leads I, II, aVL, V5 and V6 (D).Figure optionsDownload as PowerPoint slide