Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis

Authors:
  • NSNeha Sekhri
    Neha Sekhri
  • TBThomas Burchell
    Thomas Burchell
  • CKCharles Knight
    Charles Knight
  • CDCeri Davies
    Ceri Davies
  • ADAndrew Deaner
    Andrew Deaner
  • MSMichael Sheaf
    Michael Sheaf
  • SBSuhail Baithun
    Suhail Baithun
  • AWAndrew Wragg
    Andrew Wragg
  • AJAjay Jain
    Ajay Jain
  • MWMark Westwood
    Mark Westwood
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Abstract
Background In patients presenting with acute cardiac symptoms, abnormal ECG and raised troponin, myocarditis may be suspected after normal angiography. Aims To analyse cardiac magnetic resonance (CMR) findings in patients with a provisional diagnosis of acute coronary syndrome (ACS) in whom acute myocarditis was subsequently considered more likely. Methods and results 79 patients referred for CMR following an admission with presumed ACS and raised serum troponin in whom no culprit lesion was detected were studied. 13% had unrecognised myocardial infarction and 6% takotsubo cardiomyopathy. The remainder (81%) were diagnosed with myocarditis. Mean age was 45±15 years and 70% were male. Left ventricular ejection fraction (EF) was 58±10%; myocardial oedema was detected in 58%. A myocarditic pattern of late gadolinium enhancement (LGE) was detected in 92%. Abnormalities were detected more frequently in scans performed within 2 weeks of symptom onset: oedema in 81% vs 11% (pConclusions Our study emphasises the importance of access to CMR for heart attack centres. If myocarditis is suspected, CMR scanning should be performed within 14 days. Myocarditis should not be regarded as benign, even when EF is preserved.

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