Phantom Ischemia Mimicking ST Segment Elevation Myocardial Infarction in Fulminant Myocarditis / 이화의대지

ABSTRACT

A 30-year-old man visited the emergency room for chest pain, dyspnea and fever. Despite increased serum cardiac enzymes, ST segment elevation and inferior wall akinesis in electrocardiography and echocardiography, no atherosclerosis was evident in the coronary angiography. However, radionuclide myocardial perfusion image at day 2 showed a persistent perfusion defect in the left ventricular (LV) inferior wall. At day 3, prominent myocardial edema and severe LV systolic dysfunction developed with signs of heart failure. In this case, fulminant myocarditis seemed to originate from the right coronary artery territory and simulated a ST segment elevation myocardial infarction without coronary artery obstruction. The pathogenesis of the localized perfusion defect was unlcear.