The first case was a 47-year-old woman in Ho Chi Minh City, who was hospitalized with typical chest pain for two days with difficulty breathing. Cardiography shows that ST increases to the lateral area, heart enzymes increase strongly. The heart ultrasound recorded a slight reduction in dongbility, further reinforcing the suspicion of acute myocardial infarction. However, coronary scans showed that the coronary artery system was completely normal.
Thyroid testing showed suitability for acute thyroid inflammation after viral infection. The patient continued to be shown a heart MRI scan, recording cardiac edema in the lateral wall and interventricular wall, with scars under the peripherum occupying about 10% of the heart muscle but the heart function was still preserved. The patient was identified as acute myocarditis, not myocardial infarction as initially manifested.
The second case is a 30-year-old male patient, sudden chest pain, many other accompanying signs that immediately make the doctor think of a parence heart attack or widespread damage. But coronary scans are completely normal.
The patient also had a clear hyperthyroidism. Heart MRI scan showed proliferative edema, severe inflammation, scars accounting for 17% of heart muscle mass, and overflow of the pericardium, a sign of active myocarditis. Compared to female patients, this case is more severe, with a higher risk of arrhythmia and heart failure.
According to Dr. Tran Nhan Nghia - Department of Interventional Cardiology, Thu Duc General Hospital, coronary artery scans and heart MRI are two decisive methods to distinguish between myocarditis and acute myocardial infarction. A normal coronary artery helps rule out coronary blockage, while a heart MRI allows a direct look into the heart muscle structure: edema, inflammation, necrosis and scar. This is why MRI is considered the gold standard in diagnosing myocarditis.
Not only stopping at diagnosis, heart MRI also helps predict risks. Research in the journal JACC shows that the appearance of a scar on the heart muscle (LGE) increases the risk of arrhythmia and multiple deaths of the cardiovascular system. In the case of male patients in the report with a large amount of scars and edema, they are in the high-risk group and need to be closely monitored for a long time. The female patient, although lighter, had severe edema and excretion, and also needed regular check-ups to assess her recovery.
"The two cases above show that acute myocarditis after viral infection can mistakenly be mistaken for myocardial infarction. Severe chest pain is not only found in the elderly or people with underlying cardiovascular disease; healthy young people can also suffer from severe myocardial inflammation after just a common viral infection, added Dr. Nhan Nghia.
Doctors recommend that when there are symptoms such as chest pain, shortness of breath, anxiety, and unusual fatigue - especially after a viral infection, patients need to go to a medical facility early for examination and elimination of dangerous diseases such as acute myocarditis. Proper and timely diagnosis is decisive in treatment and prevention of complications.
