Acute myopericarditis complicating acute tonsillitis: beware the young male patient with tonsillitis complaining of chest pain.

OBJECTIVES: We describe 11 cases of myopericarditis complicating bacterial tonsillitis. METHODS: We performed a retrospective study of all cases of myopericarditis treated at one hospital during the years 2005 and 2006. RESULTS: The patients were all young men. The average latency from the onset of throat pain to the onset of chest pain was 4.6 days. All patients complained of chest pain. The most common electrocardiographic finding was transient ST segment elevations. The levels of cardiac enzymes and troponin were elevated in all cases. CONCLUSIONS: Otolaryngologists should be aware of this rare entity. Additional studies are indicated to evaluate the exact incidence of myopericarditis associated with acute streptococcal tonsillitis.

Pericarditis and pericardial effusion in acute ST-elevation myocardial infarction in the thrombolytic era.

BACKGROUND: Myocardial infarction-associated pericarditis is a common cause of chest pain following MI, its frequency depending on how it is defined. OBJECTIVES: To investigate the incidence of acute pericarditis and pericardial effusion in the acute phase of ST-elevation MI treated with thrombolytic therapy. METHODS: The study group comprised 159 consecutive patients fulfilling the criteria for acute MI who were admitted to our department during 18 months. Infarct-associated pericarditis was defined as the finding of a pericardial friction rub, a typical pleuropericardial pain, or both. All patients underwent physical examination of the cardiovascular system four times daily for 7 days, as well as daily electrocardiogram and echo Doppler examinations. RESULTS: Fourteen patients (8.8%) developed a friction rub and 11 patients (6.9%) had a mild pericardial effusion. Six patients (4.0%) had both a friction rub and pericardial effusion. Two patients had a friction rub for more than 7 days. Pleuropericardial chest pain was present in 31 patients (19.5%) but only 7 of them had a friction rub. The in-hospital mortality rate was 1.3% and no mortality was observed in the acute pericarditis group. CONCLUSION: The incidence of signs associated with acute pericarditis was lower in MI patients treated with thrombolysis, compared with historical controls, when a friction rub and/or pericardial effusion was present. There was no significant reduction in the incidence of pleuropericardial chest pain.

[The clinical significance of postictal electrocardiographic changes mimicking acute myocardial infarction].

The electrocardiogram (ECG) is of critical importance in the diagnosis of acute myocardial infarction. Clinical conditions such as acute pericarditis, esophageal rupture, pancreatitis, subarachnoid hemorrhage, perforated duodenal ulcer, pneumothorax and status following elective DC cardioversion result in ECG changes that include ST elevation and T wave inversion. This report aims to increase the awareness of non-cardiac syndromes, with ECG abnormalities mimicking acute myocardial infarction, and thus to avoid unjustified thrombolytic therapy. We describe the case of a patient after epileptic seizures and pathological EEG pattern. The ECG showed repolarization abnormalities suggestive of evolving acute myocardial infarction. The cardiac enzymes (except normal Troponin I) were severely elevated and coronary angiography was normal.

Fatal association of mechanical valve thrombosis with dabigatran: a report of two cases.

Several new oral anticoagulants have been approved for thromboembolism prevention in patients with nonvalvular atrial fibrillation. However, they are not yet approved for anticoagulation use in patients with prosthetic mechanical valves, and no randomized data have been published so far on their safety of use in these patients. We present two cases of patients with prosthetic mechanical mitral valves who were switched from warfarin and acenocoumarol to dabigatran and within 1 month experienced severe valve complications resulting in death. One patient experienced stroke and later cardiogenic shock and death, and the other experienced pulmonary edema, cardiogenic shock, and subsequent death.