Myocarditis and acute pancreatitis – an uncommon association

Introduction: Myocarditis can present with various, nonspecific symptoms, like dyspnoea, chest pain, cardiogenic shock, arrythmias, that may delay the diagnosis. The main cause of myocarditis is a viral infection, Coxsackieviruses type B are the cause of 50% of the cases of acute myocarditis. Coxsackieviruses are divided in two groups, A and B. Group B may cause herpangi-na, myocarditis, pericarditis, pancreatitis or hepatitis. Usually the virus affects a single organ, but simultaneous involvment of two or more organs is uncommon.
Case presentation: We present the case of a 32-year old man, ethanol consumer, with no medical history, who came at the hospital for chest pain. EKG: ST segment elevation of maximum 3 mm in V1-V4. The pacient re-ceived thrombolysis with Rapilysin and was reffered to our clinic to perform coronary angiography. On arrival in our clinic, he had no chest pain. Physical exam: he-modynamically stable, BP 150/80 mmHg, HR 75 bpm, regular, without valvular breaths, oxygen saturation of 94%. Laboratory studies: leukocytosis (13100/mm3), hypertriglyceridemia (1056 mg/dL), hypercholeste-rolaemia (248 mg/dL), myocardial necrosis enzymes slightly increased (CK=190 U/L, CK-MB=24 U/L), in-creased transaminases (AST=100 U/L, ALT=107 U/L). ECG: sinus rhythm, heart rate 75 bpm, ST-segment elevation of maximum 1,5mm in V1-V3. The ecocar-diography showed preserved ejection fraction (LVEF 55%), mild interventricular septum hypokinesia. Co-ronary angiography revealed coronary arteries without significant lesions. At about twelve hours after admissi-on, the pacient presented intense epigastric pain, which did not ceased at antialgics, and vomiting. Laboratory studies: increased pancreatic enzymes (amylase=115 U/L, lipase=965 U/L). The abdominal CT-scan showed acute edematous pancreatitis. Taking into account the significant increase of the pancreatic enzymes compa-red to the increase of the myocardial necrosis enzymes and the normal angiographic aspect of the coronary arteries, we performed a MRI, which revealed acute myocarditis. The final diagnosis: acute myocarditis, acute edematous pancreatitis, mixed dyslipidemia. The pacient received analgesics, antispasmodics, proton pump inhibitor, dual antiplatelet therapy, beta-blocker, angiotensin converting enzyme inhibitor, statin, with favorable evolution.
Conclusions: The initial clinical presentation was hi-ghly suggestive for acute myocardial infarction, but continuing the investigations on the imaging line has brought remarkable benefits to establish the diagnosis. The concomitant myocardial and pancreatic inflamma-tion has been interpreted in the context of a viral in-fection.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)