{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T10:48:10Z","timestamp":1764154090026,"version":"3.46.0"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Myocardial infarction (MI) is an exceptionally rare occurrence in young children, with most cases linked to congenital or inflammatory causes. We describe a 3-year-old girl with an unusual presentation of embolic MI secondary to dilated cardiomyopathy (DCM) and highlight the pivotal role of cardiovascular magnetic resonance (CMR) imaging in achieving an accurate diagnosis. The aim is to emphasize the importance of advanced imaging especially in rare presentations of myocardial injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We present the case of a 3-year-old girl who was admitted with lethargy and breathlessness. Examination revealed tachycardia and a systolic murmur. Investigations showed cardiomegaly on chest X-ray, elevated and rising troponin levels, and echocardiography-indicated DCM with severely impaired left ventricular function and biventricular thrombi. Initially, the diagnosis of myocarditis was considered due to elevated troponin levels. However, the evolving electrocardiographic (ECG) changes prompted further investigation with CMR. Cardiovascular magnetic resonance findings showed no myocardial oedema or inflammation, ruling out active myocarditis. Instead, it revealed a transmural myocardial infarction in the left ventricular apical segments, along with subtle mid-wall fibrosis in the basal and mid-septal areas. Additionally, severely dilated left and right ventricular volumes and significantly reduced ejection fractions were observed. These findings were consistent with an embolic MI affecting the distal left anterior descending (LAD) artery territory, most likely originating from the biventricular thrombi, in the context of severe DCM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case underscores the diagnostic complexity of myocardial injury in children and the indispensable role of CMR in distinguishing between aetiologies such as myocarditis and MI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf556","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T13:26:05Z","timestamp":1762435565000},"source":"Crossref","is-referenced-by-count":0,"title":["Unusual cause of myocardial infarction in a 3-year-old: role of cardiovascular magnetic resonance in diagnosis\u2014a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9423-2589","authenticated-orcid":false,"given":"Heba","family":"Abdlhamid","sequence":"first","affiliation":[{"name":"Cardiac MRI Department, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Sydney St, London SW3 6NP ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Krupickova","sequence":"additional","affiliation":[{"name":"Cardiac MRI Department, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Sydney St, London SW3 6NP ,","place":["UK"]},{"name":"Paediatric Cardiology Department, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Sydney St, London SW3 6NP ,","place":["UK"]},{"name":"Imperial College London , Exhibition Road, South Kensington, London SW7 2AZ ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piers","family":"Daubeney","sequence":"additional","affiliation":[{"name":"Paediatric Cardiology Department, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Sydney St, London SW3 6NP ,","place":["UK"]},{"name":"Imperial College London , Exhibition Road, South Kensington, London SW7 2AZ ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dudley","family":"Pennell","sequence":"additional","affiliation":[{"name":"Cardiac MRI Department, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Sydney St, London SW3 6NP ,","place":["UK"]},{"name":"Imperial College London , Exhibition Road, South Kensington, London SW7 2AZ ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raad","family":"Mohiaddin","sequence":"additional","affiliation":[{"name":"Cardiac MRI Department, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , Sydney St, London SW3 6NP ,","place":["UK"]},{"name":"Imperial College London , Exhibition Road, South Kensington, London SW7 2AZ ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"2025112605165890000_ytaf556-B1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1532-429X-11-19","article-title":"Normal right- and left ventricular volumes and myocardial mass in children measured by steady state free precession cardiovascular magnetic resonance","volume":"11","author":"Buechel","year":"2009","journal-title":"J Cardiovasc Magn Reson"},{"key":"2025112605165890000_ytaf556-B2","doi-asserted-by":"crossref","first-page":"419","DOI":"10.4103\/apc.apc_160_21","article-title":"Unknown origin of acute myocardial infarction and lifesaving percutaneous coronary intervention in a 10-year-old girl","volume":"15","author":"Temel","year":"2022","journal-title":"Ann Pediatr Cardiol"},{"key":"2025112605165890000_ytaf556-B3","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1016\/j.jacc.2004.11.069","article-title":"Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches","volume":"45","author":"Abdel-Aty","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"2025112605165890000_ytaf556-B4","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1148\/radiol.2371041322","article-title":"Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion cardiac MR imaging","volume":"237","author":"Laissy","year":"2005","journal-title":"Radiology"},{"key":"2025112605165890000_ytaf556-B5","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1161\/CIRCULATIONAHA.105.606509","article-title":"Presentation, patterns of myocardial damage, and clinical course of viral myocarditis","volume":"114","author":"Mahrholdt","year":"2006","journal-title":"Circulation"},{"key":"2025112605165890000_ytaf556-B6","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1161\/01.CIR.0000118493.13323.81","article-title":"Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology","volume":"109","author":"Mahrholdt","year":"2004","journal-title":"Circulation"},{"key":"2025112605165890000_ytaf556-B7","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1161\/CIRCIMAGING.113.000416","article-title":"Cardiac magnetic resonance assessment of myocarditis","volume":"6","author":"Friedrich","year":"2013","journal-title":"Circ Cardiovasc Imaging"}],"container-title":["European Heart Journal - Case 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