'Clinically suspected myocarditis with pseudoinfarct presentation' complicated with left ventricular aneurysm. (17th January 2018)

• Record Type: Journal Article
• Authors: Haouzi, Annick; Ahmed, Ahmed
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-01-17
• Subjects: cardiovascular medicine -- clinical diagnostic tests -- radiology (diagnostics); Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2017-222114
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 51-year-old man presented with chest pain, high troponin level, inflammatory syndrome and ST-segment elevation in the anterior leads. While the transthoracic echocardiogram (TTE) showed anteroseptal hypokinesis and apical akinesis, the coronary angiogram was normal. Cardiac MR demonstrated a typical aspect of myocarditis (multiple areas of mid-myocardial late gadolinium enhancement, sparing the subendocardial layer, along with oedema). The initial diagnosis was clinically suspected myocarditis with pseudoinfarct presentation. However, the short-term evolution was not typical of this syndrome, since an apical transmural scar with aneurysm developed within 2 weeks. Seven years later, the patient remained asymptomatic, while Q waves persisted in anterior leads along with an apical aneurysm on TTE. A transmural myocardial necrosis with aneurysm is an unusual complication of acute myocarditis. The potential mechanisms accounting for the development of these lesions are reviewed, and the clinical implications for the diagnosis and monitoring of acute myocarditis are discussed.