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Myocardial Infarction or Acute Myopericarditis-Reply

Peter G. Hanson, MD; Condon R. Vander Ark, MD; Myrwood C. Besozzi, MD; George G. Rowe, MD
JAMA. 1983;249(22):3018. doi:10.1001/jama.1983.03330460018018.
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In Reply.—  Drs Karjalainen and Heikkilä have emphasized the frequent similarity between acute myopericarditis and myocardial infarction. Our case report of myocardial infarction in a highly conditioned swimmer also considered the possibility of myopericarditis. However, the absence of preceding symptoms of viral illness and the highly localized uptake of technetium Tc 99m pyrophosphate in the anterolateral wall argued against myopericarditis. We did not perform viral serological studies because a primary viral isolate was not recovered from the throat.A limited number of radionuclide studies in documented viral myopericarditis have shown predominantly diffuse uptake patterns1 with a single report of localized radionuclide uptake.2 Each of these cases had definite preceding symptoms of viral illness.We agree that myopericarditis may mimick acute myocardial infarction. We also emphasize that myocardial infarction is well documented in young adults with normal coronary arteries.3 In some of these cases, exercise is a precipitating

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