Voir la suite de cet article sur Cursus ECG
Patient
35-year-old man with a viral gastrointestinal episode 2 weeks earlier; hospitalization for chest pain with fever and moderate increase in troponin;
Trace
This tracing shows a sinus rhythm, a narrow QRS, small amplitude Q-waves in the inferior leads; moderate amplitude elevation in the inferior leads; absence of reciprocity;
This patient underwent a coronary angiography (which was normal) given the association of chest pain, an increase in troponin and a systematic elevation in the inferior territory. A subsequent MRI confirmed the diagnosis of myocarditis (probably of viral origin).
An electrocardiogram was performed 4 days later in the setting of chest pain with palpitations;
Trace
Sinus tachycardia; compared to the previous tracing, the ST-segment has returned to the isoelectric line; presence of ventricular extrasystoles with a couplet and 2 different morphologies;
Exergue
It is not possible to define a typical electrocardiogram of myocarditis; it may be strictly normal, or display aspecific abnormalities similar to those observed in a coronary syndrome or pericarditis (diffuse or more localized ST-segment elevation, negative T-waves, more or less localized Q-waves).
This patient presented an episode of viral myocarditis as a result of the association between clinical setting (young patient, gastrointestinal episode 15 days earlier), chest pain, increased troponin, changes in the ECG, and normal coronary angiography. The diagnosis was confirmed by MRI.