Rheumatic carditis presenting as acute myocardial infarction.

Two weeks following streptococcal tonsillitis two patients developed migratory arthralgia, fever and pericarditic chest pain, followed by an episode of severe coronary retrosternal pressure. The ECG during the latter episodes revealed ST elevation in the inferior wall leads, followed later by the appearance of pathological Q waves in the same leads which persisted for only a few days. Radionuclide scans and echocardiographic studies revealed localized involvement of the inferior left ventricle in both cases and, in addition, involvement of the right ventricle in have been suggested to explain the co-occurrence of viral myopericarditis and myocardial infarction (MI)-like picture during acute rheumatic fever can be explained either by coronary vasculitis resulting in myocardial ischemia, or by direct involvement of the myocardium because of an inflammatory process. Both mechanisms have been suggested to explain the co-occurrence of viral myopericarditis and myocardial necrosis. The transient Q waves were probably produced by stunning of the myocytes during the acute phase of the disease. Increased awareness will probably result in detection of similar cases and may contribute to understanding the pathogenesis of the MI-like picture of acute rheumatic fever.