Myopericarditis

Patient

31-year-old male followed for vasculitis (Wegener's granulomatosis) hospitalized for chest pain and major dyspnea; biological assessment: increase in cardiac enzymes and inflammatory syndrome;

Trace

This tracing shows a sinus rhythm, a PQ segment depression in the inferior leads and in V5-V6, a PQ segment elevation in aVR, a narrow QRS, small amplitude Q-waves in the inferior leads and in V5-V6, an elevation of relatively large amplitude from V2 to V6, more moderate in inferior leads, a depression in aVR; A coronary angiography eliminated the existence of a coronary thrombosis or plaque rupture. A cardiac ultrasound and an MRI led to the diagnosis of myopericarditis (pericardial effusion with large areas of segmental hypokinesia);

Trace

This second tracing, performed the next day, allows assessing the evolving nature of the ECG; quasi-disappearance of the PQ segment depression; persistence of the ST-segment elevation with T-wave inversion from V3 to V5; A pericardial puncture was performed following the occurrence of compressive signs;

Trace

This tracing was performed 10 days after the occurrence of the first symptoms; the ST-segment is isoelectric with negative T-waves in inferior leads and from V3 to V6 (symmetrical T-waves in V4-V5) and positive in aVR;

Exergue

The electrocardiogram of myopericarditis combines characteristic signs of myocardial inflammation and signs of pericardial inflammation. The latter (PQ segment depression, diffuse transient ST-segment elevation, negative T-waves in a second instance) are generally predominant. The electrocardiographic pattern of myopericarditis often resembles that of myocarditis, the presence of Q-waves, however, potentially suggesting a myocardial involvement.