• Hossam Elmahy, Abdelrahman Abdelbar, and Matthias Schmitt.
• Department of Cardiology, Blackpool Victoria Hospital, Blackpool, UK.
• BMJ Case Rep. 2013 May 24; 2013.

AbstractA 33-year-old man without medical history or cardiovascular disease risk factors presented with recurrent progressively worsening chest pain that had been preceded by few days of flu like illness. His initial ECG and troponin rise supported the diagnosis of myopericarditis for which he was treated with aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) with good response initially. He later on developed severe recurrent chest pain and became tachycardic and hypotensive. Serial ECGs revealed a pattern of significant dynamic ST elevation in several leads, a pattern that is not usually seen in pericarditis. Subsequently, features of bedside echo did not support the diagnosis of acute ST-elevation myocardial infarction. The patient did well on conservative management with NSAIDs. He did not undergo urgent coronary angiography which would not have offered the patient any clinical benefit at the time and would have put him at procedural risk unnecessarily. The diagnosis of myopericarditis was confirmed retrospectively with typical features on cardiovascular magnetic resonance.

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