ST Segment Elevation Is Not Always Myocardial Infarction: A Case of Focal Myopericarditis

The value of dual-energy computed tomography in the evaluation of myocarditis

PURPOSE

The inflammation of the heart muscle is referred to as acute myocarditis. Cardiac magnetic resonance imaging (CMR) has become the primary method for a non-invasive assessment of myocardial inflammation. However, there are several drawbacks of CMR. During the last decade, dual energy computed tomography (DECT) has been used in cardiac imaging. The current study aims to assess the efficacy and feasibility of DECT in acute myocarditis and compare the results to CMR.

METHODS

This prospective study included patients who had myocarditis but no coronary artery pathology. Two observers evaluated the patients for acute myocarditis using DECT and CMR. CMR was performed on 22 patients within 24 hours of DECT, which was administered within 12 hours following the onset of chest pain. Inter-observer agreement was tested with Cohen's Kappa coefficient, and Spearman's correlation was used to examine the possible correlations. A P value of <0.050 was accepted as statistically significant.

RESULTS

The DECT and CMR agreement was significant for transmural diagnoses, excellent for subepicardial and intramyocardial diagnoses, and perfect for nodular and band-like patterns.

CONCLUSION

The findings of this study showed that the dark areas on the color-coded iodine map created with DECT were strongly correlated with CMR in acute cases of myocarditis. In addition, DECT is a robust imaging method that can also be used in the diagnosis of acute myocarditis. Furthermore, it provides information about coronary arteries faster and more reliably than magnetic resonance imaging without any limitations.

Stemi mimicking post COVID: a case of focal myopericarditis post COVID infection

Since the beginning of the coronavirus disease 2019 (COVID19) pandemic, several cases of myocarditis related to COVID-19 infection have been reported. These cases range from asymptomatic disease to fulminant heart failure or sudden cardiac death. Cardiac injury has also been found in asymptomatic patients and patients who recovered from the disease. Data regarding cardiovascular involvement due to COVID-19 infection are still limited, and the actual prevalence of myocarditis due to COVID-19 infection is still unknown.

We present a case of focal myopericarditis in a patient recently recovered from COVID-19 pneumonia with electrocardiogram showing ST elevation in inferior and lateral leads.

This case highlights the need for studying the long-term cardiovascular complications of COVID-19 and reinforces the use of cardiac magnetic resonance (CMR) and cardiac biomarkers in the diagnosis of COVID-19-related myocarditis.

Rabies Encephalitis With Myocarditis Mimicking ST-Elevation Myocardial Infarction

Rabies virus infection remains a significant public health threat particularly in developing countries without effective canine vaccination programs. After symptoms develop, there is no effective treatment and mortality approaches 100%. In countries such as the United States where human rabies remains rare, initial diagnosis is often delayed. In this study, we describe a case of rabies encephalitis presenting with concern for acute ST-elevation myocardial infarction (STEMI) based on electrocardiogram, laboratory, and exam findings and briefly review the known literature on cardiac involvement of rabies virus infection.