Aim To investigate the clinical manifestation,diagnosis and treatment of acute viral myocarditis as acute coronary syndromes by electrocardiogram （ECG） characteristics. Methods Retrospective analysis was carried out for the data of 20 patients adimitted to Shanghai First People’s Hospital from June 2008 to June 2014. These patients had been diagnosed as acute viral myocarditis,but looking as acute coronary syndromes. Among these patients,there were 12 males and 8 females,aged 17～60 years,mean 38 years,and 6～14 days hospitalization. Results On admission,all 20 patients showed significant higher markers of myocardial necrosis,and their ECG’s ST-segments were arched elevation in the inferior wall or front wall. During hospitalization,these patients were excluded from acute myocardial infarction by coronary angiograph or coronary computed tomography angiography （CTA）. Meanwhile,they were diagnosed as acute viral myocarditis by cardiac magnetic resonance,endomyocardial biopsy,and 4 cases were diagnosed as acute severe viral myocarditis. By applying heart failure treatment,myocardial nutrition,reducing myocardial oxygen consumption,angiotensin converting enzyme inhibitor and other comprehensive treatment,19 cases were cured,and 1 case of acute fulminant myocarditis was dead. Conclusion Part of acute viral myocarditis patients resemble the ECG characteristics and manifestations of acute coronary syndrome,and is easy to be misdiagnosed. It is necessary to combine patient history,clinical manifestations,ECG,coronary angiography,cardiac enhanced magnetic resonance examination to make timely diagnosis.