Myopericarditis
Report:
Sinus rhythm
Global T wave inversion c/c infarction/ischæmia
Comment:
The T waves show deep, if somewhat asymmetrical, inversion. The pain continued and was, at times, severe. Propranolol and nitrates did not help. As the T waves deepened further (Fig 194a), coronary angiography was done, demonstrating normal arteries; the left ventriculogram showed a normal ventricle. The patientâs pain responded to aspirin and indomethacin. The ECG normalised within 12 months.
The above appearances are not typical of myocarditis, which usually has only non-specific ST/T changes. It can mimic infarction very successfully: non-Q infarction in this case and âtransmuralâ one in Case 240. Functional impairment, obviously, has little correlation with the ECG changes.
Final diagnosis is, then, myopericarditis. This is because her initial ECG (not shown) suggested pericarditis, before the T wave inversion. I was sure before the catheter that she had a âsubendocardial infarctionâ (this in 1976), unstable, as evidenced by progressive T wave changes and continued pain. Medicine is a humbling profession.
194a.
195. 71 year old with a permanent pacemaker
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