Lea B Abucejo, Anabella A Salise-Oncog* and Julia B Maape

Governor Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol, Philippines

*Corresponding Author: Anabella A Salise-Oncog, Governor Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol, Philippines.

Received: August 17, 2021.; Published: September 24, 2021

Citation: Anabella A Salise-Oncog., et al. “Acute Myocarditis as Myocardial Infarction Mimic: Presentation of Case and Review of Literature". Acta Scientific Paediatrics 4.10 (2021): 71-77.

Abstract

Chest pain is a common symptom that results in visits to the emergency department. When it occurs, family members become worried because of the association between chest pain and cardiac disease. Although chest pain is rarely associated with serious diseases, failure to perform a timely diagnosis may result in fatalities.

This is a report on a 13-year-old obese boy who initially presented with abdominal pain and diarrhea and who subsequently complained of progressive chest pain that eventually radiated to the left arm. Initial diagnostic tests showed ST segment elevations and elevated CKMB and troponin I. He was initially managed as myocardial infarction. A 2-dimensional echocardiogram showed a low ventricular ejection fraction. Monitoring of the electrocardiogram and the cardiac enzymes showed rapid reversal of the previously seen abnormal findings, which is atypical of the course of myocardial infarction. The history, physical examination, and diagnostic findings fulfilled the criteria for acute myocarditis.

Acute myocarditis can mimic myocardial infarction and should also be considered in a patient presenting with chest pain in the Emergency Room. The clinician should be cognizant of the features outlined in this study that would help in the differential diagnoses of children presenting with chest pain. Myocarditis should be considered more than myocardial infarction in younger infants presenting with acute coronary syndrome whose ECG findings show multiple rather than single coronary artery involvement.

Keywords: Acute Myocarditis; Myocardial Infarction; ECG

Bibliography

1. Fyfe DA. “Chest pain in pediatric patients presenting to a cardiac clinic”. Clinical Pediatrics 23 (1984): 321-324.
2. Chun JH., et al. “Analysis of clinical characteristics and causes of chest pain in children and adolescents”. Korean Journal of Pediatrics11 (2015): 440-445.
3. Gesuete V., et al. “Follow-up study of patients admitted to the pediatric emergency department for chest pain”. European Journal of Pediatrics2 (2020): 303-308.
4. Subspecialty Group of Cardiology, the Society of Pediatrics, Chinese Medical Association; Collaborating Group of Myocarditis, the Subspecialty Group of Cardiology, the Society of Pediatrics, Chinese Medical Association; Editorial Board, Chinese Journal of Pediatrics; Pediatric Cardiology Committee, Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association. “Diagnostic recommendation for myocarditis in children (version 2018)”. Zhonghua Er Ke Za Zhi2 (2019): 87-89.
5. Cava JR and Sayger PL. “Chest pain in children and adolescents”. Pediatric Clinics of North America6 (2004): 1553-1568.
6. Thygesen K., et al. “Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. (2018). Fourth universal definition of myocardial infarction (2018)”. Global Heart4 (2018): 305-338.
7. Pediatric Emergency Playbook. “MI in children” (2017).
8. Mahle WT., et al. “Myocardial infarction in adolescents”. The Journal of Pediatrics2 (2007): 150-154.
9. Maslennikov GP. “The incidence of myocardial ischemia in children and adolescents. Bulletin of the Orenburg State University”. Orenburg, Kazakhstan 13.63 (2006): 256.
10. Philippine Pediatric Society (PPS), Inc. (n.d.). Myocardial infarction.
11. Paul T., et al. “Myocarditis in infants and children” (2012).
12. Allan CK and Fulton DR. “Clinical manifestations and diagnosis of myocarditis in children (2021).
13. Canter CE and Simpson KE. “Diagnosis and treatment of myocarditis in children in the current era”. Circulation1 (2014): 115.
14. Mounts AW., et al. “A cluster of fulminant myocarditis cases in children, Baltimore, Maryland”. Pediatric Cardiology1 (2001): 34.
15. Strikas RA., et al. “Temporal and geographic patterns of isolates of nonpolio enterovirus in the United States, 1970-1983”. The Journal of Infectious Diseases 2 (1986): 346.
16. Arola A., et al. “Occurrence and features of childhood myocarditis: a nationwide study in Finland”. Journal of the American Heart Association 11 (2017): e005306.
17. Wu MH., et al. “Contemporary postnatal incidence of acquiring acute myocarditis by age 15 years and the outcomes from a nationwide birth cohort”. Pediatric Critical Care Medicine 12 (2017): 1153.
18. Kim J and Cho MJ. “Acute myocarditis in children: a 10-year nationwide study (2007-2016) based on the Health Insurance Review and Assessment Service Database in Korea”. Korean Circulation Journal11 (2020): 1013-1022.
19. Philippine Pediatric Society (PPS), Inc. (n.d.). Myocarditis.
20. Freedman SB., et al. “Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation”. Pediatrics6 (2007): 1278-1285.
21. Durani Y., et al. “Pediatric myocarditis: presenting clinical characteristics”. American Journal of Emergency Medicine 8 (2009): 942-947.
22. Weber MA., et al. “Clinicopathological features of paediatric deaths due to myocarditis: an autopsy series”. Archives of Disease in Childhood 7 (2008): 594-598.
23. De Sa DJ. “Isolated myocarditis as a cause of sudden death in the first year of life”. Forensic Science International 2-3 (1986): 113-117.
24. Råsten-Almqvist P., et al. “Myocarditis and sudden infant death syndrome”. APMIS6 (2002): 469-480.
25. Kytö V., et al. “The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood”. Heart 22 (2013): 1681-1684.
26. Vashist S and Singh GK. “Acute myocarditis in children: current concepts and management”. Current Treatment Options in Cardiovascular Medicine 5 (2009): 383-391.
27. Bohn D and Benson L. “Diagnosis and management of pediatric myocarditis”. Paediatr Drugs 3 (2002): 171-181.
28. Simpson K., et al. “Myocarditis. In Moss and Adams’ Heart Disease in Infants”. Children and Adolescents, 9^th edition (2016): 1333-1330.
29. Zhang T., et al. “Acute myocarditis mimicking ST-elevation myocardial infarction: a case report and review of the literature”. Experimental and Therapeutic Medicine 2 (2015): 459-464.
30. Cooper LTJr. “Myocarditis”. The New England Journal of Medicine 15 (2009): 1526-1538.
31. Kühl U., et al. “Parvovirus B19 infection mimicking acute myocardial infarction”. Circulation 8 (2003): 945-950.
32. Bilici M., et al. “Myocardial infarction in children”. Intech Open (2018).
33. Tunuguntla H., et al. “Acute myocarditis and pericarditis in children”. Pediatrics in Review 1 (2019): 14-25.
34. Magnani JW and Dec GW. “Myocarditis: current trends in diagnosis and treatment”. Circulation6 (2006): 876-890.
35. Ang KP., et al. “Acute myocarditis mimicking ST-elevation myocardial infarction: a diagnostic challenge for frontline clinicians”. Medical Journal of Malaysia 6 (2019): 561-563.
36. Morris F., et al. “ABC of clinical electrocardiography”. BMJ Books (2003).
37. Caforio AL., et al. “Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases”. European Heart Journal33 (2013): 2636-2648.

Copyright: © 2021 Anabella A Salise-Oncog., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.