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Case Reports
. 2021 Mar 9;14(3):e237470.
doi: 10.1136/bcr-2020-237470.

Gastric perforation mimicking ST-segment elevation myocardial infarction

Ryan Enast Intan  1   2 , Fani Suslina Hasibuan  2 , Parama Gandi  3 , Firas F Alkaff  4   5
Affiliations
Case Reports

Gastric perforation mimicking ST-segment elevation myocardial infarction

Ryan Enast Intan et al. BMJ Case Rep. .

Abstract

ST-elevation myocardial infarction (STEMI) is one of the medical emergencies in cardiology with high morbidity and mortality rate which requires rapid response. In elderly patients, its presenting symptoms may be atypical which may cause the diagnosis of MI to be delayed or missed. Therefore, ST-segment elevation on ECG has become the main instrument for initial diagnosis. However, there are a variety of conditions mimicking the ECG changes of STEMI. We report a case of 70-year-old patient with acute peritonitis and pneumoperitoneum secondary to gastric perforation with dynamic ECG changes mimicking anteroseptal STEMI. After the surgery, the ECG dynamically reverted to normal. He was then discharged after 4 days without any remaining symptoms. Misinterpretation of ECG findings may lead to unnecessary aggressive intervention, costly management strategies and delay in appropriate treatment.

Keywords: emergency medicine; gastroenterology; ischaemic heart disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
ECG evaluation on admission to emergency room showed ST-segment elevation in precordial lead (1 mm in V1, 2 mm in V2 and V3) suggesting anteroseptal myocardial infarction. aVF, augmented Vector Foot; aVL, augmented Vector Left; aVR, augmented Vector Right.
Figure 2
Figure 2
Chest X-ray anteroposterior view showed no abnormalities with cardiothoracic ratio of 47%.
Figure 3
Figure 3
Abdominal X-ray evaluation (A) at supine position showed positive Rigler sign. (B) At left lateral decubitus position showed free air in peritoneal space.
Figure 4
Figure 4
Serial ECG evaluation in precordial lead during the hospitalisation showed dynamic ST-segment changes.
See this image and copyright information in PMC

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