Unexpected sudden death after percutaneous coronary intervention

BACKGROUND: Myocarditis is one of several important differential diagnoses in patients presenting with chest pain or symptoms of heart failure. The prevalence of myocarditis is probably underestimated. In young patients with sudden cardiac death, myocarditis is a common finding at autopsy. MATERIAL AND METHODS: A previously healthy 54-year-old man presented with a first episode of chest pain. Smoking was the only risk factor for coronary artery disease. RESULTS: Plasma levels of both Troponin-I and CK-MB mass were negative at admission, but were elevated in a second sample. A subtotal stenosis in the left anterior descending artery was treated with PCI. The patient was discharged after four days. He was found dead at home six days after PCI. Autopsy revealed a massive myocarditis, no signs of myocardial necrosis and only minor coronary artery disease. INTERPRETATION: This case illustrates the importance of keeping less frequent differential diagnoses in mind when patients present with chest pain. Also, this case underscores the importance of keeping a high autopsy rate; for feedback to clinicians, for correct cause-of-death statistics and for research.