Viral myocarditis masquerading acute coronary syndrome (ACS) - MRI to the rescue

A young man with a strong family history of myocardial infarction with sudden death presented with chest pain and was found to have positive cardiac biomarkers and echocardiographic evidence of inferolateral wall hypokinesia. He was managed as an acute coronary syndrome and underwent a thorough ischemic work-up which was negative. Subsequently, a cardiac MRI was performed that demonstrated a patchy subepicardial enhancement, most consistent with acute viral myocarditis. This case demonstrates the importance of cardiac MRI in distinguishing an acute coronary syndrome from viral myocarditis.