PMC9381285_01
ECG at presentation (a) and at day 4 after admission (b). (a) ST elevation in inferior and lateral leads with concave up and PR segment depression can be noticed. (b) ST resolution and T wave inversion in inferior and lateral leads.
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Electrocardiogram (ECG) in the ED showed ST segment elevation in inferior and lateral leads, pointing inferolateral wall involvement, with concave up and PR segment depression in the same leads (Figure 1(a)). T and creatine kinase progressively decreased, and ECG showed ST segment resolution with T wave inversion (Figure 1(b)). The patient was discharged home with the recommendation to avoid intense physical activity for three to six months.
Coronary angiogram ((a) left coronary artery and (b) right coronary artery) demonstrating normal coronary arteries.
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Thirty minutes after the patient's arrival at the emergency department, an emergent coronary angiography was performed to rule out acute coronary syndrome revealing normal epicardial arteries (Figure 2).
Postcontrast images of cardiac magnetic resonance (6 days after the patient's admission) in short and long views showing subepicardial enhancement in the basal and midinferior and inferolateral wall of the left ventricle (white arrows).
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T1 (1159 s) and T2 (57ms) time in comparison with the rest myocardium, confirming the diagnosis of myocarditis (revised Lake Louise criteria). Thickening and enhancement of the adjacent pericardium were also shown (Figure 3).
Postcontrast images of cardiac magnetic resonance (at 6 months) in short and long views showing minimal subepicardial enhancement in the basal inferior and inferolateral wall of the left ventricle.
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Six months after his admission, CMR was repeated and revealed normal left ventricular size and function and mild postgadolinium subepicardial enhancement in the inferior and inferolateral LV wall, compatible with healed myocarditis (Figure 4).