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  • Title: Acute streptococcal myopericarditis mimicking myocardial infarction.
    Author: Khavandi A, Whitaker J, Elkington A, Probert J, Walker PR.
    Journal: Am J Emerg Med; 2008 Jun; 26(5):638.e1-2. PubMed ID: 18534319.
    Abstract:
    A 25-year-old man who had recurrent sore throats presented with sharp central chest pain 5 hours after starting penicillin for tonsillitis. Electrocardiogram (ECG) revealed ST-segment elevation in leads I and aVL with reciprocal ST depression in lead III (Fig. 1). Troponin I was measured as 33 microg/L (normal range, b0.1 microg/L), and C-reactive protein (CRP) was 127 (normal range b10). Echocardiogram revealed a nondilated well-contracting left ventricle, and cardiac catheterization revealed normal coronary arteries. A diagnosis of acute myopericarditis was made, and he was treated with moxifloxacin. Throat swabs grew Lancefield group A Streptococcus. Over subsequent days, his symptoms and ECG changes resolved, and he was discharged on longterm prophylactic penicillin.
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