Clinical Utility of Cardiovascular Magnetic Resonance Imaging for Diagnosis of Acute Myocarditis

A 49 year-old patient with past medical history significant for arterial hypertension (treated with telmisartan 80 mg daily), presented to the emergency department with 18-hour gastric discomfort and fatigue. Five days prior to this presentation the patient had an episode of febrile gastroenteritis. The evening prior to presentation the patient had blood chemistries performed at an outside institution, where an increase of myocardial enzymes (troponin and CPK-MB) were noted. On presentation the patient was uncomfortable due to abdominal pain, but the clinical examination was almost normal. Blood pressure was 150/80 mmHg and heart rate was 60 beats/min. Cardiac S1 and S2 sounds where audible, without additional cardiac tones, murmurs, pericardial or pleural friction. There was no jugular venous distention, rales or peripheral edema present. Admission 12-lead electrocardiogram (ECG) demonstrated normal sinus rhythm with a rate of 60 beats/min, and early repolarization pattern with a slight J-point elevation in the lateral leads (I, aVL, V5, V6)