Acute myocarditis triggering coronary spasm and mimicking ac
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Myocarditis has been frequently associated in patients with acute chest pain syndrome and angiographically normal coronary arteries. When the clinical presentation plus dynamic electrocardiographic (ECG) changes is quite suggestive of an acute coronary syndrome, coronary angiography is currently the first imaging diagnostic assessment in this setting. As a complementary imaging tool, cardiovascular magnetic resonance (CMR) imaging provides a strong evidence for tissue characterization while completing the differential diagnosis.

A 24-year-old male consulted our emergency room complaining of 24 h of typical, intense on-and-off chest-pain. He had no previous medical history and no risk factors for coronary disease. There was no history suggesting a recent virus infection or drug use. During a chest pain episode in the emergency room, the ECG showed ST-segment elevation in the inferior leads. Troponin was positive on admission. An urgent coronary angiogram was performed showing angiographically normal coronary arteries, and the ECG normalized spontaneously. On the coronary care unit, 8-10 h after cardiac catheterization, the patient experienced a new episode of chest-pain with recurrence of inferior ST-segment elevation. A treatment with intravenous nitroglycerin was started which led to resolution of chest-pain and ST-segment normalization.....