CR 10: Myocarditis mimicking an acute coronary syndrome 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 Myocarditis is an inflammation of myocardium usually due to a viral infection. Clinical presentation: Heart failure + Fever Rarely: chest pain mimicking acute coronary syndromes.

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 cardiac failure.

ECG Electrocardiogram showed neither Q waves, nor repolarization abnormalities.

Chest X-Ray

Biology Troponin=1.44ng/l Positive White blood cells=11.000el/mm3 Hb= 16.4g/dl Creatinin=63µmol/l Troponin=1.44ng/l Positive CPK=348UI/l

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

Coronary angiogram: normal. 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.

Cardiac MRI RV LV Short axis view: subepicardial late enhacement involving the antero-septal wall

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

Conclusion: Cardiac MRI is the gold standard for detecting myocardial infarction (subendocardial or transmural enhacement). 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.