Myocarditis or pancreatitis?

Objective: We present the case of a young patient pre-sented with STEMI and acute pancreatitis.

Methods: A 33 years old patient, with the diagnostic of STEMI, treated by thrombolysis was addmited to our emergency department for angiography. He had no traditional risk factors for coronary artery disease, except for smoking. At presentation the ECG showed normal sinus rhythm with ST segment elevation in V1-V6, DI, aVL and ST segment depresion in DII, DIII, aVF. He had mild increase of biomarkers of cardiac ne-crosis (CK-Mb=53.7UI/L). Coronary angiography was immediately performed and revealed normal coronary arteries. The echocardiography revealed hypokinezia of the inferior septal wall with a left ventricular ejection fraction of 55-60%. In the same day, the patient com-plained about severe abdominal pain and started coffee grounds vomiting. An abdominal CT was performed and it diagnosed an edematous pancreatitis.

Results: The severe increase of the pancreatic enzymes and the mild increase of cardiac necrosis biomarkers with normal coronary arteries, raised the suspicion of a miocarditis associatted with pancreatitis. So, a car-diac MRI was performed and confirmed the diagnos-tic of acute myocarditis. This case raised two medical hypothesis. First, we considered the posibility of an inflamatory multiorgan desease caused by an infectios agent, with histotropism for pancreas and for myocar-dial muscle, like Coxsackie. On the other hand, another posibility could be a Systemic Inflamatorry Response Syndrome in the context of acute pancreatitis.

Conclusions: In conclusion, our case shows that be-hind a clasical presentation of STEMI it could be hi-ding a multiorgan inflamatory disease that creates dif-ficulties in the differential diagnosis.

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)