Differential diagnosis of myocardial infarction and myopericarditis during a pandemic

Abstract

Difficulties in the differential diagnosis of non-ST-elevation myocardial infarction (NSTEMI) and acute myopericarditis during the novel coronavirus infection (COVID-19) pandemic appear to be a relevant and interesting issue.We present a clinical case of a 55-year-old female patient with an atypical presentation of NSTEMI. Initially, the disease resembles an acute viral infection. It was known that the patient came in contact with COVID-19 infection. Taking into account that the patient had dull left chest pain unrelated to physical activities, low-grade fever, elevated levels of troponin T and acute phase reactants, absence of wall motion abnormalities, the patient was assessed as having acute viral myopericarditis. Contrastenhanced cardiac magnetic resonance imaging (MRI) showed signs of myocardial infarction. Coronary angiography confirmed myocardial infarction and the patient underwent percutaneous coronary intervention (PCI). In the article we discuss the value of electrocardiography (ECG), echocardiography and MRI in the NSTEMI diagnosis, and also additional difficulties in the COVID-19 pandemic era. Due to high probability of myopericarditis the patient received non-steroidal anti-inflammatory drugs instead of optimal medical therapy and early PCI. Our clinical case demonstrates that despite of COVID-19 pandemic significant elevation of troponin level requires adherence to the acute myocardial infarction algorithm.

Keywords

• myocardial infarction
• myopericarditis
• differential diagnosis
• pandemic
• troponin