title: Coronary Sinus Flow Is Reduced and Recovered With Time in Viral Myocarditis Mimicking Acute Coronary Syndrome: A Transthoracic Doppler Echocardiographic Study.
abstract: OBJECTIVE
  The clinical presentation of myocarditis often mimics acute coronary syndrome. Coronary sinus flow has been used for detection of the presence of myocardial ischemia. Whether myocarditis is associated with changes in coronary sinus flow remains unknown. The aim of this study was to assess coronary sinus flow at the onset and follow-up of myocarditis mimicking acute coronary syndrome using transthoracic Doppler echocardiography (TTE).
  
  
  METHODS
  Sixty-four patients with clinically diagnosed viral myocarditis mimicking acute coronary syndrome underwent TTE on days 3, 7, 30, 90, 180, and 360 after onset. Coronary sinus flow was compared among different points in time.
  
  
  RESULTS
  Compared to healthy participants, all patients with myocarditis had a larger cardiac size, reduced cardiac function, and electrocardiographic and myocardial enzyme abnormalities on days 3 and 7 days (P< .01; P< .05). They later had gradual restoration to normal levels. On days 3 and 7, the coronary sinus flow in patients with myocarditis was extremely lower than that in healthy participants (about one-tenth), although coronary angiography revealed unobstructed arteries. On days 30, 90, 180, and 360, the coronary sinus flow had been increasing; however, it was still far less than that in healthy participants (P < .01).
  
  
  CONCLUSIONS
  Coronary sinus flow depicted by TTE is reduced but recovers with time in viral myocarditis mimicking acute coronary syndrome, which is a useful indicator in the follow-up of this type of myocarditis.
authors.affiliation: Departments of Ultrasound (X.-Z.Z., J.W.) and Cardiology (Q.Z.) and Second General Surgery (W.-Z.Z.), First People's Hospital of Yancheng, Yancheng, China.
authors.forename: Xiao-Zhi
authors.initials: XZ
authors.lastname: Zheng
authors.affiliation: Departments of Ultrasound (X.-Z.Z., J.W.) and Cardiology (Q.Z.) and Second General Surgery (W.-Z.Z.), First People's Hospital of Yancheng, Yancheng, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wu
authors.affiliation: Departments of Ultrasound (X.-Z.Z., J.W.) and Cardiology (Q.Z.) and Second General Surgery (W.-Z.Z.), First People's Hospital of Yancheng, Yancheng, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Zheng
authors.affiliation: Departments of Ultrasound (X.-Z.Z., J.W.) and Cardiology (Q.Z.) and Second General Surgery (W.-Z.Z.), First People's Hospital of Yancheng, Yancheng, China. zhawenzhangzwz@163.com.
authors.forename: Wen-Zhang
authors.initials: WZ
authors.lastname: Zha
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002648:Child; D054326:Coronary Sinus / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014777:Virus Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055815:Young Adult
keywords: coronary sinus flow; echocardiography; myocardial ischemia; myocarditis