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European Heart Journal 1995 16(3):333-338;
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Outcome after thrombolytic therapy of nine cases of myopericarditis misdiagnosed as myocardial infarction

A. MlLLAIRE, P. DE GROOTE, E. DECOULX, O. LEROY and G. DUCLOUX

From the Division of Cardiology, University Hospital, University of Lille 59037 Lille Cedex, France

revised 20 July 1994; accepted 10 August 1994.

Correspondence. Alain Millaire, MD, Service de Cardiologie C, H^pilal Cardiologique, Centre Hospitalier Régional Universitaire, Blvd du Pr Leclercq, 59037 Lille Cedex, France.

Abstract

Anecdotal reports have suggested that cardiovascular complications may occur if thrombolytic therapy is performed in cases of pericarditis misdiagnosed as acute myocardial infarction. From 1980 to 1993, 47 cases of myopericarditis mimicking myocardial infarction have been admitted to our institution. The misdiagnosis was made because of clinical onset characterized by a typical chest pain, and/or localized ST segment elevation. Since 1987, nine (919 males, age 40±14 years) out of the 47 patients (19%) have been treated with a thrombolytic agent (streptokinase 419, rt-PA 519) followed by intravenous heparin. This treatment was started during the pre-hospital pliase (2/9) and while in hospital (7/9). No pericardial rub was present; ST segment elevation was mainly localized in inferior and lateral leads; no Q wave developed; median creatine kinase rise was 268 units (range 38 to 1280), and only one patient had a small pericardial effusion. The mean level of fibrinogen after thrombolysis was 1.72 g. l–1 (range 0.10 to 4.50). In all cases, typical ECG clianges were present suggesting pericarditis with a subsequent return to a normal ECG. No severe cardiac or pericardial complication or arrhytlxmia occurred; only one patient developed a non-compressive and resolvable pericardial effusion. Cardiac catheterizations (coronary and left ventricular angiographies) were normal when performed (5/9). Long-term follow-up (mean 46±29 months) was favourable without any coronary events. In conclusion, thrombolytic therapy was uncomplicated in our patients with myopericarditis simulating evolving myocardial infarction.

Key Words: Myocarditis • pericarditis • thrombolytic therapy • myocardial infarction


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