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European Journal of Heart Failure Advance Access originally published online on February 3, 2009
European Journal of Heart Failure 2009 11(4):428-431; doi:10.1093/eurjhf/hfp008
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Acute biopsy-proven lymphocytic myocarditis mimicking Takotsubo cardiomyopathy

Alida L.P. Caforio1,*, Francesco Tona1, Annalisa Vinci1, Fiorella Calabrese2, Angelo Ramondo1, Luisa Cacciavillani1, Francesco Corbetti3, Loira Leoni1, Gaetano Thiene2, Sabino Iliceto1 and Annalisa Angelini2

1 Division of Cardiology, Department of Cardiological, Thoracic and Vascular Sciences, University of Padova-Policlinico, Centro ‘V. Gallucci’, Via Giustiniani, 2, 35128 Padova, Italy
2 Department of Medico-Diagnostic Sciences and Special Therapies, University of Padua, Padua, Italy
3 Department of Radiology, University of Padua, Padua, Italy

* Corresponding author. Tel: +39 49 8212348, Fax: +39 49 876 1764, Email: alida.caforio{at}unipd.it


  Abstract

Endomyocardial biopsy (EMB), the diagnostic gold standard for myocarditis, has not been systematically performed in the reported case series of Takotsubo cardiomyopathy, although proposed Mayo Criteria specify exclusion of myocarditis. Moreover, there is no specific recommendation for infarct-like acute myocarditis in the recently published guidelines on the role of EMB. Here we present a thoroughly documented case fulfilling both the proposed Mayo criteria for Takotsubo cardiomyopathy and the World Health Organization criteria for active, virus-negative, immune-mediated myocarditis. Since myocarditis can mimic acute myocardial infarction with normal coronary arteries, EMB should be performed to rule out myocarditis in patients presenting with LV apical ballooning syndrome (or Takotsubo cardiomyopathy).

Key Words: Myocarditis • Takotsubo cardiomyopathy • Autoimmunity • Acute myocardial infarction with normal coronary arteries

Received September 13, 2008; Revised December 3, 2008; Accepted December 10, 2008


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