Acute rheumatic fever mimicking an acute coronary syndrome

▸ An elevated troponin does not always reflect myocardial ischaemia secondary to obstructive coronary artery disease. Troponin levels can also be elevated in other disease states including acute rheumatic fever (ARF).

A 22 year old Caucasian male was admitted as an emergency to the coronary care unit with a 12 hour history of retrosternal chest discomfort. On examination he looked unwell, was pyrexial and had a pulse rate of 105 bpm. There was no cardiac murmur or rub on auscultation. Respiratory and abdominal examination was normal. A 12 lead ECG showed infero-lateral ST elevation and an ST elevation myocardial infarction was presumed. Urgent coronary angiography was undertaken. The epicardial coronary arteries were angiographically normal, however, the 12 hour troponin T (TnT) …