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Case Reports
. 2020 Apr 17;9(4):186-188.
doi: 10.1097/XCE.0000000000000205. eCollection 2020 Dec.

A 78-year-old male with inferior ST-segment elevation on electrocardiogram, diabetic ketoacidosis and acute pancreatitis

Jamie S Y Ho  1 , Bryan Mui  2 , Ching-Hui Sia  3   4 , Andie H Djohan  3 , Shao-Feng Mok  5 , Mark Y Chan  3   4 , Anand A Ambhore  3
Affiliations
Case Reports

A 78-year-old male with inferior ST-segment elevation on electrocardiogram, diabetic ketoacidosis and acute pancreatitis

Jamie S Y Ho et al. Cardiovasc Endocrinol Metab. .

Abstract

A 78-year-old male presented with shortness of breath, metabolic acidosis, severe hyperglycaemia and ketonemia. Inferior ST-elevation was present on 12-lead ECG with raised troponin I, but coronary arteries were normal on emergency cardiac catheterization. Despite no previous history of diabetes mellitus and normal HbA1c levels 7 months prior, diabetic ketoacidosis (DKA) was diagnosed, complicated by subsequent shock. The underlying cause was acute pancreatic disease, supported by elevated pancreatic enzyme levels and a history of chronic heavy alcohol use. There are no previous reports, to our knowledge, of patients with acute pancreatitis presenting to the ED with secondary DKA mimicking STEMI.

Keywords: ST elevation; ST-elevation myocardial infarction; acute pancreatitis; diabetes mellitus; diabetic ketoacidosis; hyperkalaemia.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
(a) 12-lead electrocardiogram in emergency department showing equivocal ST-segment elevation in inferior leads (leads II, III and aVF), with equivocal reciprocal ST segment depression in lead I and aVL, confounded by motion artifacts. (b and c) Ultrasound of the hepatobiliary system showing fatty liver with small hepatic cysts, thickened gallbladder with sludge and tiny gallstones, prominent CBD. Mildly bulky pancreas appearance may relate to history of pancreatitis, no focal lesion seen. CBD, common bile duct; GB, gallbladder; IVC, inferior vena cava; SpV, splenic vein.
See this image and copyright information in PMC

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