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Case Reports
. 2020 Apr 15;2(4):604-610.
doi: 10.1016/j.jaccas.2020.02.016. eCollection 2020 Apr.

Gastrointestinal Distention Masquerading as ST-Segment Elevation Myocardial Infarction

James Zhang  1 , Hussain Basrawala  1 , Sumit Patel  1 , Hartaj Girn  1 , Vaughn Eyvazian  1 , Lan Wang  1 , Enrique Ostrzega  1
Affiliations
Case Reports

Gastrointestinal Distention Masquerading as ST-Segment Elevation Myocardial Infarction

James Zhang et al. JACC Case Rep. .

Abstract

ST-segment elevation myocardial infarction (STEMI) is the most serious manifestation of acute coronary syndrome. A variety of noncardiac conditions can mimic STEMI on electrocardiography (ECG). We describe a case of gastrointestinal distention and ileus masquerading as STEMI on ECG and posits a mechanism for this effect. (Level of Difficulty: Intermediate.).

Keywords: ACS, acute coronary syndrome; ECG, electrocardiography; ICU, intensive care unit; STEMI; STEMI, ST-segment elevation myocardial infarction; electrocardiography; gastric distention.

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Figures

None
Graphical abstract
Figure 1
Figure 1
ECG Following Onset of ST-Segment Elevations on Telemetry A 12-lead electrocardiogram (ECG) with apparent ST-segment elevations in the precordial leads with accompanying deep T-wave inversions, J-point depression in the inferior leads, and marked QT prolongation.
Figure 2
Figure 2
12-Lead Continuous ECG With Abdominal Palpation 12-lead continuous electrocardiogram (ECG) initially with ST-segment elevations in precordial leads. Following abdominal palpation with an ultrasound probe, ST-segment elevations resolved. Onset of abdominal palpation is denoted by the red arrow.
Figure 3
Figure 3
12-Lead Continuous ECG With Release of Abdominal Palpation Following release of abdominal pressure, ST-segment elevations were demonstrated again. Offset of abdominal palpation is denoted by the red arrow. ECG = electrocardiogram.
Figure 4
Figure 4
Abdominal Radiograph of Gastrointestinal Distention Abdominal radiograph demonstrated significant gastric distention along with colonic ileus.
Figure 5
Figure 5
Follow-Up ECG After Gastrointestinal Decompression A 12-lead electrocardiogram (ECG) following gastrointestinal decompression demonstrating normal sinus rhythm.
Central Illustration
Central Illustration
Gastric Distention as a Cause of ST-Segment Elevation and the Proposed Mechanisms Leading to This Effect Noncardiac disorders may mimic ST-segment elevation myocardial infarction on electrocardiogram. Such causes include gastric distention, pancreatitis, intracranial hemorrhage, cholecystitis. and pneumonia. The effect of gastric distention on electrocardiogram is highlighted in this case report, as well as the proposed mechanisms leading to this effect.
See this image and copyright information in PMC

References

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