Akut İnferior St Segment Elevasyonlu Miyokard İnfarktüsünü Taklit Eden Akut Miyokardit
Özet
Akut miyokardit, klinik ve elektrokardiyografik (EKG) bulgularıyla akut miyokard infarktüsünü taklit edebilen inflamatuvar bir miyokard hastalığıdır. Özellikle koroner arter hastalığı açısından düşük riskli genç hastalarda ayırıcı tanıda akılda tutulmalıdır. Bu bölümde, akut inferior ST segment elevasyonlu miyokard infarktüsü (MI) ön tanısıyla değerlendirilen ancak koroner anjiyografide obstrüktif koroner arter hastalığı saptanmayan 23 yaşındaki kadın olgu sunulmaktadır. Kardiyak manyetik rezonans (KMR) görüntülemede T2 ağırlıklı sekanslarda miyokardiyal ödem ve geç gadolinyum kontrastlanmasında (Late gadolinyum enhancement- LGE) subepikardiyal non-iskemik tutulum izlenmesi üzerine akut miyokardit tanısı doğrulanmıştır. Olgu, akut göğüs ağrısı ve ST segment elevasyonu ile başvuran genç hastalarda miyokarditin önemli bir ayırıcı tanı olduğunu ve KMR’ın doğru tanının konulmasında temel non-invaziv yöntemlerden biri olduğunu göstermektedir.
Acute myocarditis is an inflammatory myocardial disease that may mimic acute myocardial infarction in terms of both clinical presentation and electrocardiographic findings. It should be considered in the differential diagnosis, particularly in young patients with a low risk profile for coronary artery disease. In this section, we present the case of a 23-year-old woman who was initially evaluated with a presumptive diagnosis of acute inferior ST-segment elevation myocardial infarction but was found to have no obstructive coronary artery disease on coronary angiography. Cardiac magnetic resonance (CMR) imaging demonstrated myocardial edema on T2-weighted sequences and a non-ischemic subepicardial pattern of late gadolinium enhancement, confirming the diagnosis of acute myocarditis. This case highlights that myocarditis represents an important differential diagnosis in young patients presenting with acute chest pain and ST-segment elevation and emphasizes the pivotal role of CMR as a non-invasive imaging modality for establishing an accurate diagnosis.
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