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European Heart Journal Advance Access originally published online on June 14, 2006
European Heart Journal 2006 27(15):1885; doi:10.1093/eurheartj/ehl089
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Differentiation of aborted myocardial infarction from masquerading myocardial infarction

Daniel Petrov

Department of Emergency Cardiology and Acute Internal Diseases
‘Pirogov’ Emergency Hospital
21 Macedonia Avenue
Sofia 1606
Bulgaria
Tel: +359 889 393 652
E-mail address: dpetrov{at}techno-link.com

Svetlozar Sardowski

Department of Emergency Cardiology and Acute Internal Diseases
‘Pirogov’ Emergency Hospital
21 Macedonia Avenue
Sofia 1606
Bulgaria

We read with great interest the article by Verheugt et al.1 dealing with aborted myocardial infarction (MI) as a new target for reperfusion therapy. The authors emphasize the importance of differentiating between aborted MI and masquerading MI to avoid inappropriate fibrinolysis. The most common differential diagnoses of patients with masquerading MI are given in Table 1 of the article. While we agree that the diseases listed there (acute pericarditis, aortic dissection, previous MI with recurrent myocardial ischaemia in same area, left ventricular aneurysm, left ventricular hypertrophy, early depolarization, left bundle branch block, pre-excitation, Brugada syndrome) can often lead to a potentially false diagnosis of aborted MI (i.e. masquerading MI), we would like to expand this list by including yet another case. In August 2004, we reported a previously unpublished case of reversible myocardial ischaemia following acute upper airway obstruction.2 The patient was admitted in the emergency department with marked respiratory distress as a result of oropharyngeal and epiglottic swelling. Electrocardiogram revealed pronounced ST-segment elevation in V3–V6 and a subtler one in inferior leads with reciprocal depression in I, {alpha}VL, and V1. The ST-segment elevation returns to normal 10 min later with the relief of the upper airway obstruction (intubation was performed), without any evidence of myocardial damage.

This is a typical example of masquerading MI and we believe that our experience with this case can benefit clinical practice in the future.

References

  1. Verheugt FWA, Gersh BJ, Armstrong PW. (2006) Aborted myocardial infarction: a new target for reperfusion therapy. Eur Heart J 27:901–904.[Abstract/Free Full Text]
  2. Petrov DB, Sardowski SI, Milanov SP. (2004) Reversible myocardial ischemia following acute upper airway obstruction. Heart Lung 33:235–236.[CrossRef][Web of Science][Medline]

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This Article
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