Cardiopathia fantastica exposed by rapid sequential serum creatine kinase analysis

Abstract

Rapid, sequential serum creatine kinase measurements may be used to exclude acute myocardial infarction in patients presenting with acute chest pain. Two cases of cardiopathia fantastica (the cardiac variant of Munchausen's syndrome) are described. Both patients presented with symptoms of acute myocardial infarction and had electrocardiographic changes consistent with this diagnosis. Both patients also had a raised serum creatine kinase level at the time of presentation but were unable to mimic the rise in serum creatine kinase associated with acute myocardial infarction. Munchausen's syndrome was suspected when both patients responded poorly to news that their enzyme results excluded acute myocardial infarction.