A Case of Viral Myocarditis Presenting as Acute Extensive Myocardial Infarction

ABSTRACT

Viral myocarditis is a inflammatory process of the heart caused by virus. Its manifestation ranges from asymptom to acute fulminent congestive heart failure and often mimics acute myocardial infarction. A 22 year old man was admitted to the hospital because of prolonged anterior chest pain. 15 days before entry, anterior chest pain with cough and fever brought him to the another hospital. At that time, the LDH level was 1160U/L, the CPK level was 659.7U/L and MB band was 16.1%. The ECG revealed acute inferior wall infarction. And 3 days later, extensive anterior wall infarction findings appeared. 2D-Echo findings showed proximal septal hypokinesia. On admission time to this hospital, physical examination was negative. The ECG showed no interval change. 2D-Echo findings showed increased echogenicity of anterior and inferior wall. Treadmill test did not evoked chest pain or change of ECG. The LDH, CPK levels returned to normal range. The antibody titers of Coxsackievirus type A-16 was positive. Coronary angiography showed normal findings. 3 months later, antibody's titer of Coxsackievirus A-16 was increased. A diagnosis of acute viral myocarditis was made.