Presumptive myocarditis with ST-Elevation myocardial infarction presentation in young males as a new syndrome. Clinical significance and long term follow up.

BACKGROUND: Acute myocarditis may mimic myocardial infarction, since affected patients complain of "typical" chest pain, the ECG changes are identical to those observed in acute coronary syndromes, and serum markers are increased. We describe a case series of presumptive myocarditis with ST segment elevation on admission ECG. METHODS AND RESULTS: From 1998 to 2009, 21 patients (20 males; age 17-42 years) were admitted with chest pain, persistent ST segment elevation, serum enzyme and troponine release. All but one patients had fever and flu-like symptoms prior to admission. No abnormal Q wave appeared in any ECG tracing, and angiography did not show significant coronary artery disease. Patients remained asymptomatic at long term follow-up, except 2 who experienced a late relapse, with the same clinical, electrocardiographic and serum findings as in the first clinical presentation. CONCLUSION: Presumptive myocarditis of possible viral origin characterized by ST elevation mimicking myocardial infarction, good short term prognosis and some risk for recurrence is relatively frequent in young males and appears as a distinct clinical condition.

Electrocardiographic features in critical pulmonary embolism. Results from baseline and continuous electrocardiographic monitoring.

BACKGROUND: Pulmonary embolism (PE) afflicts millions of individuals worldwide. Electrocardiography along with chest X-ray and arterial blood gas analysis represent the basic examinations to reinforce the clinical suspicion of PE. We describe the electrocardiographic (ECG) features in a series of patients with PE and a critical clinical presentation. METHODS: We report the ECG findings registered at baseline, 48 hours after admission and on continuous ECG monitoring in 51 patients with PE and critical clinical conditions. RESULTS: At admission, the following parameters were recorded: an S1Q3 pattern in 34 patients, a "septal embolic pattern" in 27, anterior lead T-wave inversion in 8, and a new right bundle branch block in 7. At 48 hours after admission a trend toward a regression of the S1Q3 and "septal embolic" patterns was noted together with evident T-wave inversion in the anterior leads. During continuous ECG monitoring no major arrhythmias were recorded, even in case of cardiopulmonary arrest. CONCLUSIONS: Critical PE induces transient ECG abnormalities reflecting right ventricular overload and/or strain. The patient's clinical status is usually not complicated by major ventricular arrhythmias, not even in case of cardiopulmonary arrest.