Myocarditis differential diagnosis: Difference between revisions
| Line 22: | Line 22: | ||
===Cardiac Biomarkers=== | ===Cardiac Biomarkers=== | ||
Myocarditis is associated with elevations of the [[CK-MB]] and the [[troponin]], while pericarditis is not. If [[pericarditis]] is associated with underlying inflammation of the [[myocardium]], then this is called [[myopericarditis]]. If there is concomitant involvement of both the [[pericardium]] and [[myocardium]] in [[myopericarditis]], then there are elevations of the [[cardiac biomarkers]]. | Myocarditis is associated with elevations of the [[CK-MB]] and the [[troponin]], while pericarditis is not. If [[pericarditis]] is associated with underlying inflammation of the [[myocardium]], then this is called [[myopericarditis]]. If there is concomitant involvement of both the [[pericardium]] and [[myocardium]] in [[myopericarditis]], then there are elevations of the [[cardiac biomarkers]]. | ||
===Echocardiography=== | |||
In patients with myocarditis there will be a focal wall motion abnormalities, while these will be absent in the patient with pericarditis. There may be a [[pericardial effusion]] in the patient with [[pericarditis]], while myocarditis is not associated with a [[pericardial effusion]]. | |||
==References== | ==References== | ||
Revision as of 13:45, 5 September 2011
|
Myocarditis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Myocarditis differential diagnosis On the Web |
|
American Roentgen Ray Society Images of Myocarditis differential diagnosis |
|
Risk calculators and risk factors for Myocarditis differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Myocarditis presents with chest pain and ST segment elevation. Myocardiits must be distinguished from pericarditis and the life threatening condition of ST elevation myocardial infarction.
Differentiating Myocarditis from ST Segment Elevation Myocardial Infarction
Both diseases present with chest pain, elevated cardiac biomarkers, and focal left ventricular dysfunction. There are two studies that can be used to distinguish the two syndromes:
Coronary Angiography
Coronary angiography can be performed to distinguish myocarditis from ST segment elevation myocardial infarction. ST segment elevation myocardial infarction is associated with either complete or subtotal occlusion of an epicardial coronary artery on coronary angiography.
Cardiac Magnetic Resonance Imaging
Cardiac magnetic resonance imaging is also useful in distinguishing between the two syndromes as well. On cardiac MRI, myocarditis is associated with patchy, non-sentimental, hyperenhancement which is confined to the epicardial layer of the myocardium. In contrast, in ST segment elevation myocardial infarction there is confluent hyperenhancement extending from the endocardium in a distribution that mimics the distribution of the epicardial coronary arteries.
Differentiating Myocarditis from Pericarditis
Both diseases present with chest pain and ST segment elevation. The two conditions can be distinguished by the following studies:
Electrocardiogram
While both disorders are associated with ST segment elevation, pericarditis is also associated with PR segment depression.
Cardiac Biomarkers
Myocarditis is associated with elevations of the CK-MB and the troponin, while pericarditis is not. If pericarditis is associated with underlying inflammation of the myocardium, then this is called myopericarditis. If there is concomitant involvement of both the pericardium and myocardium in myopericarditis, then there are elevations of the cardiac biomarkers.
Echocardiography
In patients with myocarditis there will be a focal wall motion abnormalities, while these will be absent in the patient with pericarditis. There may be a pericardial effusion in the patient with pericarditis, while myocarditis is not associated with a pericardial effusion.