Özgür ENGİNYURT, Zeki Yüksel GÜNAYDIN, Yusuf Emre GÜREL, Ahmet KAYA

Akut miyokardit ve akut miyokart infarktüsü ikilemi: vaka sunumu

Göğüs ağrısı ve St segment elevasyonu ile gelen hastalarda düşünülecek ilk tanı akut miyokart infarktüsüdür. Ancak akut miyokart infarktüsü bazen miyokardit gibi bazı hastalıklarla karışabilir. Akut miyokart infarktüsü ve miyokardit ayrımı hikaye, fizik muayene, elektrokardiyografi, ekokardiyografi ve kardiyak-spefik enzimlerle yapılır.Bu iki hastalığın tedavi ve prognozu birbirinden tamamen farklıdır. Ayırıcı tanıya varmak ve koroner anjiografi kararı verebilmek hayat kurtarıcıdır. Bu iki hastalığın ayırımında elektrokardiyografi çok önemlidir. Elektrokardiyografi bulguları farklı olmasına rağmen, bazen akut miyokart infarktüsü ve akut miyokardit birbirini taklit edebilir. Fokal ST elevasyonu ile birlikte resiprokal ST depresyonu bulunan 22 yaşında miyokardit tanısı konulan bir hastayı sunduk.

Anahtar Kelimeler:

Miyokardit, miyokart infarktüsü, prinzmental Angina, koroner anjiografi

The Dilemma of acute myocarditis and acute myocardial infarction: a case report

The first diagnosis in patients with chest pain and ST segment elevation is acute myocardial infarction. But acute myocardial infarction sometimes can be confused with other diseases such as myocarditis. Discrimination of acute myocardial infarction and acute myocarditis can be made by history, physical examination, electrocardiography, echocardiography and cardiac-specific enzymes. The treatment and prognosis of those two diseases are completely different. The differential diagnosis and decision of coronary angiography is lifesaving. Electrocardiography is very important in the differentiation of these two diseases. Although ECG findings are different, acute myocarditis and acute myocardial infarction sometimes imitate each other. 22 years old male patient diagnosed as myocarditis and focal ST elevation with reciprocal ST depression presented in this case.

Keywords:

Myocarditis, myocardial infarction, prinzmental angina, coronary angiography,

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1.Pitts SR, Niska RW, Xu J, Burt CW, US Dept of Health and Human Services National hospital ambulatory medical care survey: 2006 emergency department summary. Natl Health Stat Report. 2008; 6: 1-38.
2.Nisbet BC, Breyer M. Acute myopericarditis with focal ECG findings mimicking acute myocardial infarction. J Emerg Med 2010; 39: 153-8
3. Coppola G, Carità P, Corrado E, Borrelli A, Rotolo A, Guglielmo M, Nugara C, Ajello L, Santomauro M, Novo S. ST segment elevations: Always a marker of acute myocardial infarction? Indian Heart J. 2013; 65: 412-23
4. Kontos MC, Diercks DB, Kirk JD. Emergency Department and Office-Based Evaluation of Patients With Chest Pain , Mayo Clin Proc. 2010; 85: 284-299
5. Karjalainen J, Heikkilä j. Incidence of three presentations of acute myocarditis in young men in military service. A 20-year experience. J Eur Heart J. 1999 ; 20: 1120-5.
6. Kusama Y1, Kodani E, Nakagomi A, Otsuka T, Atarashi H, Kishida H, Mizuno K. Variant angina and coronary artery spasm: The clinical spectrum,pathophysiology, and management. J Nippon Med Sch 2011; 78: 4-12
7. Ariyarajah V, Spodick DH. Acute Pericarditis Diagnostic Cues and Common Electrocardiographic Manifestations. Cardiology in Review 2007; 15: 24–30
8. Nageh T, Sherwood RA, Harris BM, Byrne JA, Thomas MR. Cardiac troponin T and I and creatine kinase-MB as markers of myocardial injury and predictors of outcome following percutaneous coronary intervention. Int J Cardiol. 2003; 92: 285-93
10. Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmüller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH. Guidelines on the diagnosis and management of pericardial diseases, executive summary; the Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J 2004; 25: 587–610
11. Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, Moratti M, Gaschino G, Giammaria M, Ghisio A, Belli R, Trinchero R. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial Circulation 2005; 112: 2012–6.