Infant acute myocarditis mimicking acute myocardial infarction

Myocarditis is an inflammatory disease of the myocardium with heterogeneous clinical manifestations and progression. In clinical practice, although there are many methods of diagnosis of acute myocarditis, the diagnosis remains an embarrassing dilemma for clinicians. The authors report the case of 9-month-old infant who was brought to the Pediatric Emergency Department with sudden onset dyspnea. Examination disclosed heart failure and resuscitation was undertaken. The electrocardiogram showed an ST segment elevation in the anterolateral leads with a mirror image. Cardiac enzyme tests revealed a significant elevation of troponin and creatine phosphokinase levels. A diagnosis of acute myocardial infarction was made, and heparin therapy was prescribed. The infant died on the third day after admission with cardiogenic shock. The autopsy showed dilatation of the ventricles and massive edema of the lungs. Histological examinations of myocardium samples revealed the presence of a marked lymphocytic infiltrate dissociating myocardiocytes. Death was attributed to acute myocarditis. The authors call attention to the difficulties of differential diagnosis between acute myocarditis and acute myocardial infarction especially in children, and to the important therapeutic implications of a correct diagnosi

Infant acute myocarditis mimicking acute myocardial infarction

Myocarditis is an inflammatory disease of the myocardium with heterogeneous clinical manifestations and progression. In clinical practice, although there are many methods of diagnosis of acute myocarditis, the diagnosis remains an embarrassing dilemma for clinicians. The authors report the case of 9-month-old infant who was brought to the Pediatric Emergency Department with sudden onset dyspnea. Examination disclosed heart failure and resuscitation was undertaken. The electrocardiogram showed an ST segment elevation in the anterolateral leads with a mirror image. Cardiac enzyme tests revealed a significant elevation of troponin and creatine phosphokinase levels. A diagnosis of acute myocardial infarction was made, and heparin therapy was prescribed. The infant died on the third day after admission with cardiogenic shock. The autopsy showed dilatation of the ventricles and massive edema of the lungs. Histological examinations of myocardium samples revealed the presence of a marked lymphocytic infiltrate dissociating myocardiocytes. Death was attributed to acute myocarditis. The authors call attention to the difficulties of differential diagnosis between acute myocarditis and acute myocardial infarction especially in children, and to the important therapeutic implications of a correct diagnosi

Death in detention in Sousse, Tunisia: a 10-year autopsy study

Abstract Background Mortality rates and causes of death of the detainees are hence different from those of the general population and there also vary according to regions and countries. Aims To study the peculiarities of death among individuals detained in the region of Sousse in Tunisia and to suggest preventive measures. Material and methods This is a descriptive retrospective study of all deaths in detention collated in the Forensic Medicine department of Farhat Hached teaching hospital in Sousse, Tunisia during a 10-year period 2006 to 2015. Results 26 deaths were collected. All the victims were males. The mean age was 39.5 years. The deaths occurred inside the prison in 42.3% and 57.7% in a hospital. The deaths were of natural causes in 69.2%. The most common natural causes were cancer (6 cases, 33.3%) and infections (5 cases,27.8%). Violent death accounted for 31.8% of deaths with 08 victims. Suicide and homicide were the violent death causes most incriminated each with 11.5% (3 cases). The suicide means was hanging in all cases. The death was accidental in 2 cases (7.7%). Conclusion This study shows that a large proportion of deaths among prisoners are preventable. Prevention is, on the one side, by improving the prison health coverage and on the other side by training the prison staff on the identification of suicidal crises and on controlling the technical devices facilitating the transition to the suicidal act, in particular the hanging cases