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(Circulation. 2001;103:e95-a.)
© 2001 American Heart Association, Inc.

Correspondence

Myocardial Infarction After Dog Bite

Peter Bogaty, MD

Quebec Heart Institute/Laval Hospital, 25 Chemin Ste-Foy, Ste-Foy, Quebec, Canada G1V 4G5, peter.Bogaty@med.ulaval.ca

To the Editor:

Scharf and Widmer describe a case of dog bite resulting in sepsis, implicating the Gram-negative bacteria Capnocytophaga canimorsus, with accompanying chest discomfort, ST-segment elevation, and a cardiac enzyme rise.¹ They conclude that myocardial infarction occurred as a complication of bacteremia "in the absence of both hypotension and endocarditis." They did not consider another possibility that should have entered into the differential diagnosis given the following elements of the clinical presentation: (1) although the presenting ECG might at first glance suggest transmural ischemia and an acute inferolateral myocardial infarction, it is uncharacteristic to find ST elevation in lead I and an upsloping ST segment in V₂ and V₃, rather than reciprocal ST depression given this degree of ST elevation in inferolateral leads; (2) echocardiography showed diffuse left ventricular hypokinesia and not the typical regional akinesia expected with an inferolateral infarction; and (3) in the absence of embolic endocarditis or severe sustained hypotension, there is no plausible pathogenic link (and the authors suggest none) between bacteremia/disseminated intravascular coagulation and the acute occlusion of an epicardial coronary artery leading to myocardial infarction, and the latter is rarely, if ever, described as a complication of the former. The far more likely diagnosis is toxic-infectious myocarditis, which can notoriously mimic acute myocardial infarction.² Acute myocarditis would better account for the atypical ECG features and the diffuse left ventricular hypokinesia in the context of a severe systemic clinical presentation.

References

1. Scharf C, Widmer U. Myocardial infarction after dog bite. Circulation. 2000;102:713–714.[Free Full Text]
   
2. Narula J, Khaw BA, Dec GW Jr, et al. Brief report: recognition of acute myocarditis masquerading as acute myocardial infarction. N Engl J Med. 1993;328:100–104.[Free Full Text]
   

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