Myocarditis Mimicking STEMI Complicated by Complete Atrioventricular Block: Diagnostic and Therapeutic Insights

  • Rido Mulawarman Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0003-2169-0971
  • Hiradipta Ardining National Cardiac CenteDepartment of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesiar Harapan Kita
  • Celly Anantaria Atmadikoesoemah Division of Non-Invasive Diagnostic and Cardiovascular Imaging, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • Dony Yugo Hermanto Division of Arrhythmia and Electrophysiology, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0002-6540-6103
  • Bambang Widyantoro Division of Clinical Cardiology, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0001-5325-4125
  • Rarsari Soerarso National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0002-4992-6686
DOI: https://doi.org/10.30701/ijc.1921
Keywords: Myocarditis, STEMI mimic, atrioventricular block, cardiac magnetic resonance, case report

Abstract

Background: Myocarditis, or myocardial inflammation, may share similar characteristics to Acute Coronary Syndrome (ACS), particularly ST-Elevation Myocardial Infarction (STEMI). This condition is further augmented when a Complete Atrioventricular Block (CAVB) is present. Despite being rare, this condition may pose additional diagnostic and therapeutic challenges.

Case Illustration:  We report a 54-year-old woman with fatigue, dyspnea, fever, nausea, and watery diarrhea for three days. Upon admission, she experienced hypotension, pulmonary congestion, and a complete Atrioventricular (AV) block, with ST-segment elevation seen on the lateral leads. Initial laboratory results revealed markedly elevated high-sensitivity troponin T and C-reactive Protein (CRP). Bedside echocardiography showed a prominently reduced Ejection Fraction (EF) (40%) alongside the presence of regional wall motion abnormalities. Urgent coronary angiography revealed only non-obstructive coronary disease and no obstructive coronary disease. A temporary pacemaker and inotropic support were initiated. Given the presence of systemic prodromal symptoms and the absence of coronary obstruction, myocarditis was strongly suspected. High‑dose intravenous methylprednisolone was given as an anti‑inflammatory treatment in suspected fulminant myocarditis with cardiogenic shock and complete AV block. Recognizing that immunosuppressive therapy is not routinely recommended for all myocarditis cases, especially without biopsy confirmation. Cardiac magnetic resonance imaging subsequently confirmed myocarditis, demonstrating myocardial edema and subepicardial late gadolinium enhancement. The patient was discharged after receiving guideline-directed medical therapy and tapering corticosteroids, with preserved ventricular function on follow-up 1 month after discharge.

Conclusions: This report illustrates the importance of a stepwise diagnostic approach to differentiate myocarditis from STEMI, particularly when complicated by conduction disturbances such as CAVB. Early recognition and timely initiation of immunosuppressive therapy can lead to favorable outcomes.

Downloads

Download data is not yet available.

Author Biography

Rarsari Soerarso, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia

Division of Clinical Cardiology, Department of Cardiology and Vascular Medicine

References

1. Martens P, Cooper LT, W.H. Wilson Tang. Diagnostic Approach for Suspected Acute Myocarditis: Considerations for Standardization and Broadening Clinical Spectrum. Journal of the American Heart Association. 2023 Sep 5;12(17).
2. Ammirati E, Frigerio M, Adler ED, Basso C, Birnie DH, Brambatti M, et al. Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy. Circulation: Heart Failure. 2020 Nov;13(11).
3. Caforio ALP, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Heart Journal. 2013 Jul 3;34(33):2636–48.
4. Maisch B. Cardio-Immunology of Myocarditis: Focus on Immune Mechanisms and Treatment Options. Frontiers in Cardiovascular Medicine. 2019 Apr 12;6.
5. Pedrotti P, Conca C, et al. Registro Lombardo delle Miocarditi. Clinical presentation and outcome in a contemporary cohort of patients with acute myocarditis: multicenter lombardy registry. Circulation. 2018;138:1088–99. doi: 10.1161/CIRCULATIONAHA.118.035319
6. Aquaro GD, Perfetti M, Camastra G, Monti L, Dellegrottaglie S, Moro C, Pepe A, Todiere G, Lanzillo C, Scatteia A, et al; Cardiac Magnetic Reso- nance Working Group of the Italian Society of Cardiology. Cardiac MR with late gadolinium enhancement in acute myocarditis with preserved systolic function: ITAMY study. Am Coll Cardiol. 2017;70:1977–87. doi: 10.1016/j.jacc.2017.08.044
7. Hang W, Chen C, Seubert JM, Wang DW. Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes. Signal Transduction and Targeted Therapy. 2020 Dec;5(1).
8. Ferone E, Segev A, Tempo E, Gentile P, Elsanhoury A, Baggio C, et al. Current treatment and immunomodulation strategies in Acute Myocarditis. Journal of Cardiovascular Pharmacology [Internet]. 2024 Feb 9. doi: 10.1097/FJC.0000000000001542
Published
2026-06-11
Views & Downloads
Abstract views: 42   
PDF downloads: 17   
How to Cite
Mulawarman, R., Ardining, H., Atmadikoesoemah, C., Hermanto, D., Widyantoro, B., & Soerarso, R. (2026). Myocarditis Mimicking STEMI Complicated by Complete Atrioventricular Block: Diagnostic and Therapeutic Insights. Indonesian Journal of Cardiology. https://doi.org/10.30701/ijc.1921
Issue
Online First
Section
Case Reports

Copyright (c) 2026 Indonesian Journal of Cardiology

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

    • Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
    • Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    • Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).