Perimyocarditis may coexist with acute myocardial infarction

摘要

The relation of acute myocardial infarction (AMI) with ST elevation (STEMI) and perimyocarditis has been viewed simply and exclusively as differential diagnostic one. The aim of the paper is to show arguments for the case that perimyocarditis may coexist with AMI: The same infective/inflammative cause of perimyocarditis may affect coronary artery ("coronaritis"), leading to AMI. In patients with perimyocarditis tachycardia, hypotension, acute heart failure, etc. may occur, which are well-known pathophysiologic mechanisms capable of leading to type two MI. Perimyocarditis can lead to left ventricle (and atrium in atrial fibrillation) thrombus formation. Such thrombus can embolize in coronary artery, producing AMI. Coronary artery spasm can also occur in a patient with perimyocarditis, due to stress, smoking, cocaine, methamphetamine, etc. and result in AMI (if lasting enough). Conclusion: Acute perimyocarditis is an important differential diagnosis of STEMI, because inappropriate administration of thrombolytic (fibrinolytic) may lead to fatal outcome. There is no analysis of the possibility of concomitant occurrence of acute perimyocarditis and AMI in the available literature. In this paper arguments are presented for the case that perimyocarditis might coexist with AMI. Diagnostic workup and therapeutic approach for this situation have been studied.