title: Diagnostic Approach to Myocarditis Mimicking Myocardial Infarction at Initial Presentation.
abstract: We present a case of a 35-year-old male patient with a 12-hour history of sudden-onset, crushing chest pain and associated complaints of profuse diaphoresis, nausea and vomiting. The patient was transferred to our institution from an outside hospital for evaluation and possible emergent catheterization. Left heart catheterization was conclusive for normal coronary arteries and a ventriculogram revealed a left ventricular ejection fraction of approximately 45%. Due to a suspicion of myocarditis based on clinical history, pertinent serology tests were ordered, which were found to be negative. Cardiac magnetic resonance on delayed enhancement imaging showed typical sub-epicardial enhancement in a pattern most consistent with myocarditis. The patient was eventually diagnosed with myocarditis and discharged home later, without needing a myocardial biopsy. We present and discuss here the indications of myocardial biopsy and compare the relative utility of cardiac magnetic resonance imaging in formulating the diagnosis of myocarditis.
authors.affiliation: St John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Basman
authors.affiliation: St John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Pratik R
authors.initials: PR
authors.lastname: Agrawal
authors.affiliation: University of Alabama at Birmingham (UAB) Medical Center, Birmingham, Alabama, AL, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: McRee
authors.affiliation: St John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Saravolatz
authors.affiliation: Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Chen-Scarabelli
authors.affiliation: St John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, MI, USA; University of Alabama at Birmingham (UAB) Medical Center, Birmingham, Alabama, AL, USA; Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
authors.forename: Tiziano M
authors.initials: TM
authors.lastname: Scarabelli
keywords: Cardiac MRI; Endomyocardial biopsy; Myocarditis