A Rare Case Of Acute Perimyocarditis Presenting With Refractory VT And Mimicking As Acute MI

Abstract

Perimyocarditis is an acute inflammation of pericardium and underlying myocardium resulting in myocellular damage. It remains a rare diagnosis and manifests with a wide spectrum of non-specific symptoms that include chest pain, dyspnea, and palpitations associated with electrocardiographic abnormalities that resemble that of ST-elevation myocardial infarction (STEMI). Therefore, clinical diagnosis is often challenging and is often misdiagnosed. We report a 64/F with perimyocarditis in which initially ECG changes masqueraded as acute MI and later on Ventricular tachycardia complicated the picture. Since 4 days patient was experiencing episodes of intermittent retrosternal chest pain mild to moderate in intensity which occurred during exertional activity and was relieved with rest, non radiating, non referred. ECG was done which showed ST elevation in anterior leads. ECHO revealed RWMA. Her troponin was 1.9 ng/ml (range- 0-.05 ng/ml), Her NT- pro BNP was 7000 pg/ml (range – 0-125 ng/ml). Her CAG revealed normal epicardial coronaries. Serial ECG showed persistent ST segment elevation. Patient was diagnosed with probable acute perimyocarditis and thus treated with IV antibiotics using ceftriaxone 1 gm x12 hrly and Inj. Levoflox 500 mg iv 24 hrly and correction of electrolyte imbalance.