Acute Pancreatitis Mimicking Acute Inferior Myocardial Infarction

Tejada, Julio García; Hernández, Felipe; Chimeno, Javier; Alonso, Martina; Martín, Roberto; Bastante, Teresa

doi:10.1177/0003319707304533

Cited by 12 publications

(10 citation statements)

References 11 publications

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“…ECG abnormalities have been frequently documented in patients with acute pancreatitis. The most common ECG changes consist of nonspecific repolarization abnormalities (1). Although documented, ST-segment elevation is rare (1-4).…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis mimicking the electromechanical manifestations of st-segment elevation myocardial infarction

Khan¹,

Chang²

2014

Curr Res Cardiol

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T he mechanism for electrocardiographic (ECG) abnormalities in the setting of acute pancreatitis remains unknown. We present a case involving a patient diagnosed with acute pancreatitis who had ECG findings suggestive of inferior ST-segment elevation myocardial infarction (STEMI) with concordant inferior wall motion abnormalities on echocardiography and patent coronary arteries. CASE PRESENTATIoNA 78-year-old man presented to a peripheral hospital after experiencing 2 h of nonexertional epigastric pain with progressive radiation to his chest. This was associated with nausea and diaphoresis, but no dyspnea, palpitations or presyncope. Electrocardiography was performed and revealed ST-segment elevation in the inferior leads suggestive of myocardial infarction (MI) ( Figure 1A). The patient was transferred for cardiac catheterization. Physical examination of the patient revealed a diffusely distended abdomen with tympanic bowel sounds, but no signs of peritonitis. Although acute pancreatitis was suspected, the authors decided to proceed with coronary angiography to determine whether there was concomitant occlusion of a coronary artery. A minimal amount of contrast agent was used. Coronary angiography was only notable for calcified nonobstructive lesions in the left anterior descending artery (40% to 50%) and right coronary artery (20% to 30%) ( Figures 1B and 1C). The left circumflex artery was small in size, supplied a small territory and had only mild narrowing. Echocardiography revealed hypokinesis of the inferior wall with mild reduction in right ventricular function (Figure 2). Subsequent electrocardiography demonstrated resolution of the ST-segment elevation (Figure 3). Mild electrocardiographic abnormalities are often observed in the setting of acute pancreatitis. The authors report a case involving a patient diagnosed with acute pancreatitis who had electrocardiographic findings of ST-elevation myocardial infarction with concordant echocardiographic findings of wall motion abnormalities, but patent coronary arteries and no evidence of myocardial injury on pathology. key Words: Acute pancreatitis; ECG abnormalities; ST elevationThis open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http:// creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact support@pulsus.com

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Section: Discussionmentioning

confidence: 99%

Acute pancreatitis mimicking the electromechanical manifestations of st-segment elevation myocardial infarction

Khan¹,

Chang²

2014

Curr Res Cardiol

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“…The most commonly encountered ECG findings in the studies performed in AP cases are changes in the ST-T interval (13,14,24,25). Repolarization changes in these studies were described to be "nonspecific".…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, electrocardiographic (ECG) findings were evaluated, and "nonspecific" repolarization was described to be the most common ECG finding detected among ST-T changes, and it was reported to be an unimportant finding (13,14). However, the clinical significance of this finding and influence on the prognosis was not evaluated sufficiently.…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic changes and importance of repolarization changes in cases with acute pancreatitis

Sokmen¹,

Bugdaci²,

Öztekin³

2011

Turk J Gastroenterol

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“…AP has frequently been reported to be associated with transient electrocardiographic (ECG) changes such as ST-T changes mimicking myocardial infarction, sinus bradycardia (5), repolarization changes (6), nonspecific T wave changes and accelerated atrial or nodal rhythms (7) have also been reported in early phase of acute pancreatitis. In addition, QT interval changes, particularly early repolarization was described to be the most common ECG finding of AP patients (8,9). QT dispersion was defined as an index of the spatial dispersion and attributed to difference of ventricular recovery times (10).…”

Section: Introductionmentioning

confidence: 99%

QT interval changes and reversibility of QT dispersion in patients with acute pancreatitis

Bugdaci¹,

Tüzün²,

Koca³

et al. 2015

Turk J Gastroenterol

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Background/Aims: QT dispersion is a sign of heterogeneity of ventricular myocardial wall and is associated with cardiac mortality and morbidity. Data regarding with the persistence of QT interval changes in cases with acute pancreatitis (AP) that required clinical follow-up, are insufficient. Therefore, in this study, we aimed to evaluate the QT interval changes during attack and after remission of the disease, in cases with AP. Materials and Methods: The cases admitted to the Gastroenterohepatology Clinic with the diagnosis of AP were included into the study. Ranson's score parameters, electrocardiography and echocardiography of all patients included into the study were evaluated. Electrocardiographic changes were evaluated two times, during attack and after remission of the disease. Results: A total of 134 subjects (F/M:54/80, 41/59%) diagnosed as AP were included into the study. Seventy two (54%) of the AP cases included into the study were biliary, 32 (24%) were alcohol dependant, 19 (14%) were idiopathic, 9 (7%) were hyperlipidemic and 2 (1%) were ERCP related cases. Mean age of the patents was 57.7±15 years old (range: 19-82 years old) and mean Ranson's score was 3.8±1.9 (range: 1-7), according to the numerical scoring system. We compared QT interval changes during the attack and after the remission of AP and found significant increase in QT dispersion levels during acute attack of AP (p<0,001). Conclusion:The most common electrocardiographic changes in AP patients are QT interval changes including QT dispersion. QT dispersion which was emerged during the attack recovered after the remission of the disease.

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Acute Pancreatitis Mimicking Acute Inferior Myocardial Infarction

Cited by 12 publications

References 11 publications

Acute pancreatitis mimicking the electromechanical manifestations of st-segment elevation myocardial infarction

Acute pancreatitis mimicking the electromechanical manifestations of st-segment elevation myocardial infarction

Electrocardiographic changes and importance of repolarization changes in cases with acute pancreatitis

QT interval changes and reversibility of QT dispersion in patients with acute pancreatitis

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