[Unexpected sudden death after percutaneous coronary intervention].
BACKGROUND
Myocarditis is one of several important differential diagnoses in patients presenting with chest pain or symptoms of heart failure. The prevalence of myocarditis is probably underestimated. In young patients with sudden cardiac death, myocarditis is a common finding at autopsy.


METHODS
A previously healthy 54-year-old man presented with a first episode of chest pain. Smoking was the only risk factor for coronary artery disease.


RESULTS
Plasma levels of both Troponin-I and CK-MB mass were negative at admission, but were elevated in a second sample. A subtotal stenosis in the left anterior descending artery was treated with PCI. The patient was discharged after four days. He was found dead at home six days after PCI. Autopsy revealed a massive myocarditis, no signs of myocardial necrosis and only minor coronary artery disease.


CONCLUSIONS
This case illustrates the importance of keeping less frequent differential diagnoses in mind when patients present with chest pain. Also, this case underscores the importance of keeping a high autopsy rate; for feedback to clinicians, for correct cause-of-death statistics and for research.
Gravning
Jørgen
J
Nasjonalforeningen for folkehelsen, Det norske hjerte-karrådet, Institutt for kirurgisk forskning. j.a.gravning@medisin.uio.no
Vege
Ashild
A
Kjekshus
John
J
D000787:Angina Pectoris / Q000175:diagnosis; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis; D023921:Coronary Stenosis / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D049429:Forensic Pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications* / Q000473:pathology; D009206:Myocardium / Q000473:pathology