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Acute Myocarditis — EECC MCQ

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ModerateCardiomyopathyAcute MyocarditisEECC

A 48-year-old woman presents with acute chest pain, ST-elevation in the anterior leads, and troponin I elevation of 3500 ng/L. Coronary angiography is normal. Cardiac MRI shows diffuse myocardial oedema with patchy mid-wall and epicardial late gadolinium enhancement in the lateral wall. There is no LV thrombus. What is the most likely diagnosis?

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Correct answer: E — Acute myocarditis

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · A = shown as D · B = shown as E

The combination of chest pain, ST-elevation, troponin rise, normal coronaries, and CMR findings of diffuse myocardial oedema with mid-wall/epicardial LGE is characteristic of acute myocarditis. Per the 2025 ESC Myocarditis and Pericarditis Guidelines, CMR is the key diagnostic tool using Lake Louise Criteria. Takotsubo (A) would show apical ballooning without LGE. Sarcoidosis (C) has basal septal LGE and chronic presentation. Recanalisation (D) would show subendocardial LGE. HCM (E) would show hypertrophy.

Reference: ESC (2025): Guidelines for the Management of Myocarditis and Pericarditis