**10. Myocarditis**

**8. Kawasaki disease**

**I.** Anomalous origin of ≥1 CA from pulmonary trunk

**a.** LMCA or LAD from pulmonary trunk **b.** Both CAS from pulmonary trunk **c.** RCA from pulmonary trunk

**II.** Anomalous origin of ≥1 CA from Aortic Sinus **a.** LMCA and RCA from right Aortic Sinus **b.** RCA and LMCA from left Aortic Sinus **c.** LCx and RCA from right Aortic Sinus

**d.** RCA and/or LMCA from posterior Aortic Sinus

**Table 5.** Taylor classification of congenital coronary artery abnormalities.

**e.** RCA and LAD from right Aortic Sinus

**III.** Single CA ostium from Aorta **IV.** Congenital hypoplastic CAs

descending, RCA: right coronary artery.

**V.** CA fistula

112 Myocardial Infarction

and erythematous rash.

slightly elevated.

**9. Takotsuba cardiomyopathy**

Kawasaki disease is a self-limiting acute vasculitis. Children aged between 5 months and 5 years are especially sensitive to Kawasaki disease. It is one of the most common causes of vasculitis and MI in children [41, 42]. Destruction in the coronary arteries, ectasia and coronary artery aneurisms are frightening complications of the disease [43]. Diagnosis is made from the presence of four of the five diagnostic criteria together with unexplained fever ongoing for at least 5 days. The diagnostic criteria are bilateral non-purulent conjunctivitis, oropharynx changes, cervical lymphadenopathy, persistent oedema in the hands and feet

LCx: left circumflex, CA: Coronary artery, CAs: Coronary arteryies, LMCA: left main coronary artery, left anterior

Takotsuba cardiomyopathy is a benign clinical condition characterised by chest pain, elevated ST segment on ECG and elevated cardiac enzymes [31]. It is thought to be stress-related. It develops more often with emotional stress and sometimes related to physical stress. Due to chest pain and shortness of breath, it mimics acute myocardial infarction. There is ballooning and/or systolic dysfunction on echo or left ventriculography [32]. Coronary angiography is normal and there is no coronary artery disease. Cardiac enzymes are normal or may be As myocarditis is generally seen together with pericarditis, it is known as myopericarditis. Myopericarditis may show differences according to whether the effects of the clinical findings are focal or generalised [19]. Typically, diagnosis is made from the determination of chest pain, the sound of pericardial friction, ST elevation on ECG, high levels of troponin I, cardiomegaly on telecardiography and pericardial effusion on echo (**Table 6**).

Pericardial effusion is observed in 60% of pericarditis patients. Wall movement abnormalities on echo or systolic dysfunction are a warning sign of myocarditis and/or MI. As the ECG findings in myopericarditis are focal in 50% of cases, differential diagnosis from AMI can be difficult. The presence of PR segment depression on II is a valuable finding of myopericarditis [19]. It has been suggested that coronary thrombus, coronary spasm, coronary artery embolism, large vessel and microvascular vasculitis could be reasons for MI seen in myopericarditis [33, 34]. In follow-up,


**Table 6.** Differential diagnosis of myocardial infarction and myocarditis.

thinning and fibrosis in the MI area may be seen in echocardiographic examination and in unaffected parts, compensatory hypertrophy may be present. Although it is difficult to apply in infants, endomyocardial biopsy is the gold standard in myocarditis. The death of myocites and inflammatory cells may be seen in biopsy material [36]. Another diagnostic method is cardiac MRI, which requires general anaesthesia. An increase in cardiac signal and increased myocardial contrast involvement is seen on cardiac magnetic resonance imaging [37].
