Health Ministry Announces Increased Budget for Rural Clinics
A policy brief on the newly announced budget allocation for rural clinic infrastructure.
Editorial staff
March 15, 2026
3 min read
Introduction
Acute myocarditis in young, otherwise healthy adults is an uncommon but clinically significant cause of chest pain and troponin elevation, frequently mimicking acute coronary syndrome on initial presentation.1 Distinguishing myocarditis from an acute coronary event early is essential, since management and short-term risk differ substantially.2 We describe a young adult presenting with pleuritic chest pain and a markedly elevated troponin trend following a recent viral illness.
Case Presentation
A 24-year-old previously healthy man presented to the emergency department with two days of pleuritic chest pain, low-grade fever, and fatigue, one week after a self-limited upper respiratory illness. Electrocardiography showed diffuse concave ST-segment elevation without reciprocal changes. Initial high-sensitivity troponin I was mildly elevated at 0.8 ng/mL. Coronary risk factors were absent and the patient was hemodynamically stable throughout admission.
Investigations
Serial troponin I measurements over the following 72 hours showed a rise-and-fall pattern more consistent with myocarditis than an evolving coronary occlusion, corroborated by cardiac MRI findings of subepicardial late gadolinium enhancement in the inferolateral wall — a pattern well described in viral myocarditis.3
Discussion
The differential for young patients presenting with chest pain and troponin elevation includes acute coronary syndrome, pericarditis, and myocarditis.4 A preceding viral prodrome, diffuse (rather than territorial) ECG changes, and a troponin trajectory that peaks and resolves within days — rather than the more sustained elevation typical of infarction — favor myocarditis, as does subepicardial (rather than subendocardial) late gadolinium enhancement on MRI.5 Most cases in young, hemodynamically stable patients are self-limited and managed conservatively, though structured follow-up is warranted given a small but recognized risk of late ventricular dysfunction.67
Conclusion
Myocarditis should remain a key differential in young adults presenting with chest pain and troponin elevation following a viral illness. Serial troponin trends and cardiac MRI are valuable in distinguishing it from acute coronary syndrome and guiding a conservative management approach.8
References
- Caforio ALP, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-2648.
- Kociol RD, Cooper LT, Fang JC, et al. Recognition and initial management of fulminant myocarditis: a scientific statement from the American Heart Association. Circulation. 2020;141(6):e69-e92.
- Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations. J Am Coll Cardiol. 2018;72(24):3158-3176.
- Sharma A, Gurung R. Distinguishing acute coronary syndrome from myocarditis in young adults: a diagnostic approach. J Cardiol Nepal. 2024;12(3):145-152.
- Luetkens JA, Faron A, Isaak A, et al. Comparison of original and 2018 Lake Louise criteria for diagnosis of acute myocarditis. Radiol Cardiothorac Imaging. 2019;1(3):e190010.
- Ammirati E, Frigerio M, Adler ED, et al. Management of acute myocarditis and chronic inflammatory cardiomyopathy: an expert consensus document. Circ Heart Fail. 2020;13(11):e007405.
- Anzini M, Merlo M, Sabbadini G, et al. Long-term evolution and prognostic stratification of biopsy-proven active myocarditis. Circulation. 2013;128(22):2384-2394.
- Thapa B, Karki S. A case series of viral myocarditis mimicking acute coronary syndrome in a tertiary centre in Nepal. Ajna Health Lens. 2025;1(3):22-29.
