Analysis of Acute Severe Myocarditis Misdiagnosed as Acute Anterior Myocardial Infarction

LI Li; LEI Song

doi:10.3969/j.issn.1002-3429.2018.03.001

Abstract：Objective To summarize the clinical characteristics of severe acute myocarditis,and to analyze the reason for misdiagnosis as acute anterior myocardial infarction,in order to reduce the misdiagnosis rate and improve diagnosis and treatment.Methods We retrospectively analyzed the clinical data of 4 patients with acute severe myocarditis who were admitted to our hospital from May 2014 to May 2017.Results All patients in this group had a history of upper respiratory tract infection before onset,which was manifested as chest pain,palpitation and adams-stokes syndrome with syncope (n =2),chest tightness and shortness of breath (n =3),cardiac shock,abdominal pain,nausea and vomiting associated with epigastric pain (n =1).The electrocardiogram showed anterior myocardial infarction.Both blood leukocyte counts and myocardial enzyme spectrum were elevated,and virology results were positive.In addition,the ultrasonic electrocardiogram (ECG) abnormality was noted.This group was misdiagnosed as acute anterior myocardial infarction,and the misdiagnosis time was 1-4 (2.13 ± 0.72) d.All 4 patients underwent coronary artery angiography and isotope myocardial perfusion imaging (CAM),both of which were unremarkable.In combination with clinical manifestations and medical examination results,those patients were diagnosed as having severe acute myocarditis.Two weeks after initial treatment,the clinical symptoms were alleviated.ECG and laboratory index returned to normal.The patients were discharged home in stable condition.All patients were followed up for six months,and had favorable prognosis.Conclusion In clinical practice,severe acute myocarditis may be taken into account in terms of a history of respiratory infection and resembling acute anterior myocardial infarction.In addition to dynamic analysis of changes in ECG,it is of great significance to perform timely coronary angiography,thereby avoiding or reducing the misdiagnosis.