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(Circulation. 2001;103:e95.)
© 2001 American Heart Association, Inc.

Correspondence

Myocardial Infarction After Dog Bite

Johann Auer, MD; Robert Berent, MD; Bernd Eber, MD

Department of Cardiology and Intensive Care, General Hospital Wels, Wels, Austria

To the Editor:

We do not agree with the diagnosis of myocardial infarction in the case of a 36-year-old man 2 days after a dog bite¹ . For several reasons, we believe that the patient had myopericarditis rather than myocardial infarction.

First, the patient had symptoms, signs, and laboratory findings consistent with sepsis, and blood cultures yielded Capnocytophaga canimorsus. Myocardial infarction occurs occasionally in patients with bacteremia, and it usually results from sepsis-associated hypotension or from endocarditis with septic embolism to the coronary arteries. However, viral and bacterial infections are more commonly the cause of pericarditis and myocarditis.^{2 3} ECG patterns of acute myopericarditis are known to resemble those seen with acute myocardial infarction.⁴ The presented ECG demonstrated ST elevations in both anterior and inferior leads in a manner consistent with the pattern found in acute myopericarditis.^{4 5}

Second, the absence of regional wall motion abnormalities and the documentation of diffuse hypokinesia with left ventricular systolic dysfunction are typically seen in myopericarditis. Abnormal regional wall motion is nearly universally present in acute myocardial infarction. Presentation with chest discomfort and laboratory examinations with elevated levels of creatine kinase and raised troponin-I concentrations are consistent with myopericarditis as well as with myocardial infarction.

Third, coronary angiography demonstrating normal vessels without signs of atherosclerosis is also consistent with the diagnosis of myopericarditis. This finding makes acute myocardial infarction less likely but does not definitely rule out previous coronary artery occlusion.

In summary, we think that the diagnosis of acute myopericarditis is more likely than acute myocardial infarction in the reported case.¹

References

1. Scharf C, Widmer U. Myocardial infarction after dog bite. Circulation. 2000;102:713–714.[Free Full Text]
   
2. Lorell BH, Braunwald E. Pericardial disease. In: Braunwald E, ed. Heart Disease. 4th ed. Philadelphia: Saunders; 1992:1465–1472.
   
3. Zayas R, Anguita M, Torres F, et al. Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol. 1995;75:378–382.[Medline] [Order article via Infotrieve]
   
4. Goldberger AL, Goldberger E. Miscellaneous ECG patterns: pericarditis and pericardial effusion; myocarditis. In: Goldberger AL, Goldberger E, eds. Clinical Electrocardiography. 5th ed. St Louis: Mosby Year Book; 1994:131–133.
   
5. Eber B, Auer J, Berent R. Perikarditis. In: Eber B, ed. EKG: Einfach, Kurz, Genau. 2nd ed. Graz, Austria: Leykam; 1998:51.
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Auer, J. Articles by Eber, B. Search for Related Content PubMed PubMed Citation Articles by Auer, J. Articles by Eber, B. Related Collections Acute myocardial infarction Electrocardiology Pericardial disease Coronary imaging: angiography/ultrasound/Doppler/CC