PMC6945368_01
a) ECG on admission demonstrates mild respiratory sinus arrhythmia with a frequency of 95 beats per minute (bpm). Concave ST segment elevation in leads I, II, III, aVF, V4-V6 is obvious and no reciprocal ST segment depression of rest leads is detected, findings that could be associated with possible myocarditis (taking into account the elevated troponin and the echocardiogram findings). Note the presence of a non-typically ischemic q wave in inferior and lateral leads, potentially frustrating any treating doctor; b) ECG 4 days post-admission. Normal sinus rhythm 78 bpm. Note the progress of the initial repolarization disorders with all the previously affected leads now demonstrating T waves inversion. Minimal q waves can be noticed in I, aVL; c) Follow up ECG, two months after discharge. Normal sinus rhythm 85 bpm. Repolarization pattern is practically restored. T waves inverted in lead III and flattened in aVF are merely noted
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Abnormal findings were noted on the Electrocardiogram (ECG) (Figure 1). There was a gradual fall of troponin, while ECG continued to be abnormal (Figure 1) but repeated ECHOs demonstrated normalization of left ventricular function. At follow up, two months later, the patient was asymptomatic, in good health, and the ECG had returned to normal (Figure 1).
CMRI revealing an area with late gadolinium enhancement (arrowhead) at mid-wall myocardial layers of mid posteroseptal and inferior LV wall without accompanied pericardial enhancement
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A Cardiac Magnetic Resonance Imaging (CMRI) on the day before patient discharge revealed findings which supported the diagnosis of acute myocarditis without pericardial involvement (Figure 2).