Abstract

To the Editor: Although the diagnosis of perimyocarditis was not and could not be completely ruled out, the clinical presentation, EKG changes, and cardiac enzymes pattern were more consistent with acute myocardial injury (probably secondary to more than one vessel coronary spasm). The patient presented with acute chest pain that responded to nitroglycerin. The global hypokinesia is consistent with multivessel coronary spasm. Although the patient became asymptomatic, her left ventricular dysfunction persisted. There were no viral syndrome symptoms at any time before admission, and no pericardial effusion was seen. The chest pain was not pericardial in nature. It is more common to see diffused T-wave changes with myocarditis than with localized ST elevation, and the fact that ST elevation resolved quickly, without following the usual pattern of pericarditis EKG changes, is more consistent with coronary spasm. All of the above, in addition to the chronological correlation of starting the new medicine one week before the acute presentation, point to a cause-and-effect relation between the medication administration and presentation with acute myocardial injury that was hypothetically caused by a severe and transient coronary spasm.