Key result
In three young patients presenting with STEMI-like ECG changes, a diagnosis of focal myocarditis was made and treatment with ibuprofen and colchicine reversed abnormal ECG findings within three days.
Case Report (n=3)
No
Focal myopericarditis is an important differential diagnosis for STEMI in young patients with acute chest pain and ST elevation, as misdiagnosis can lead to inappropriate and potentially harmful thrombolytic therapy.
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Consider focal myocarditis in young patients with STEMI-like ECG to avoid inappropriate thrombolysis; case reports leave open the role of ibuprofen-colchicine.
Distinguishing ST-elevation myocardial infarction (STEMI) differential diagnoses is more challenging. Myopericarditis is one of these differentials that results from viral involvement of myocardium and pericardium of the heart. Myopericarditis in focal form can mimic acute STEMI in its electrocardiogram (ECG) features and elevated cardiac enzymes. Myocarditis patients may face thrombolytic related complications such as intracranial bleeding, myocardial rupture, and hemorrhagic cardiac tamponade. Furthermore, re-administration of streptokinase (a common thrombolytic agent in our country) is banned for at least six months of previous administration; however, it can save patients' lives in emergency conditions such as massive pulmonary embolism. It seems that, when dealing with a young patient presenting to emergency department with acute chest pain and ST segment elevation on ECG, we should consider focal myocarditis as an important but rare differential diagnosis of STEMI. In this report, we describe three cases of focal myocarditis, primarily misdiagnosed as STEMI.
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Nozari et al. (2016) conducted a case report in Focal myopericarditis mimicking STEMI (n=3). Ibuprofen and Colchicine was evaluated on Reversal of abnormal ECG findings and preservation of ejection fraction. In three young patients presenting with STEMI-like ECG changes, a diagnosis of focal myocarditis was made and treatment with ibuprofen and colchicine reversed abnormal ECG findings within three days.
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