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.

[Atrail fibrillation and heart failure: a complex relationship]. / La complessa interazione tra fibrillazione atriale e scompenso cardiaco.

Atrial fibrillation (AF) and heart failure (HF) often coexist in the same patient, not only because they can result from the same heart disease, but also because each of them can directly lead to the other. In the genesis of AF, structural, electrical and functional factors share a key role, but the importance of any of them is variable, according to the different clinical situations. AF causes atrial changes, electrical, anatomical or both, that can result in maintenance, recurrence and even irreversibility of the arrhythmia. In addition, AF affects the ventricular function by: a) loss of atrioventricular synchrony; b) irregular ventricular response; c) rapid ventricular response, possibly leading to tachycardia-induced cardiomyopathy. AF, thus, can "beget" HF, even in subjects with a previously normal heart. On the other hand, HF often "begets" AF. The prevalence of AF in patients with HF, indeed, increases from 5% (NYHA class I) to 50% (NYHA class IV). The mechanisms of HF-induced AF, include: a) increase of "critical atrial mass"; b) atrial stretch, with mechanoelectrical feedback; c) neuroendocrine changes; and d) extracellular matrix fibrosis. In brief, there is an important association between HF and development of AF and vice versa. AF-induced prognosis worsening of HF patients is not always true: in advanced HF, thus, no evidence has been obtained that the arrhythmia is associated with a decreased survival. This observation, as well as the lesson from "rhythm" versus "rate" control clinical trials, can help the management of AF in HF. The so-called "non channel target therapy" could be of value in this context.

Myocarditis with ST-Elevation Myocardial Infarction presentation in young man. A case series of 11 patients.

Acute myocarditis may mimic an infarction. Aim is to describe a case series of peculiar myocarditis. From 1997 to 2003, 11 male patients (age 17-39 years) were admitted with diagnosis of acute myocardial infarction, localized ST segment elevation and minimal enzyme release. Ten patients had fever in the 3 days prior to admission. Eight patients underwent coronary angiography showing normal coronary arteries. All remained asymptomatic at long term follow-up. In conclusion, myocarditis with ST elevation myocardial infarction presentation is an acute benign syndrome especially frequent in young males.