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Fulminant myocarditis complicated with obstructive ST-elevation myocardial infarction—a rare case report

Published:February 04, 2013DOI:https://doi.org/10.1016/j.ajem.2012.10.022
      Acute myocarditis mimicking ST-elevation myocardial infarction has been reported in the literature, and most of the cases had relatively normal coronary arteries. However, there is no literature mentioning fulminant myocarditis complicated with obstructive myocardial infarction. Herein, we report a 72-year-old male suffering from progressive dyspnea and acute chest pain after recent common cold episode. Electrocardiography revealed ST elevation over inferior leads and emergent coronary angiography showed right coronary artery occlusion, but left ventriculography revealed poor left ventricular (LV) function with global hypokinesia, different from previously normal echocardiographic finding 3 months previously. After percutaneous coronary intervention, extracorporeal membrane oxygenation was also instituted due to unstable hemodynamic and electrical conduction disturbance. Fulminant myocarditis was highly suspected according to the clinical course and incompatible LV function. This patient finally expired a few days later due to no obvious recovery of LV function and family's willing. This case reminds physicians that acute coronary occlusion is still a possible but extremely rare complication of fulminant myocarditis. Despite intensive mechanical support, this kind of patient might have poorer prognosis than other myocarditis cases without coronary occlusion and hence need more attention.
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