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

Abstract

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

Acute Pancreatitis with Electrocardiographic Changes Mimicking Acute Coronary Syndrome: A Diagnostic Conundrum

“…Many cases also reported alternate mechanisms involving coronary vasospasm (Khan et al 2014). This reaction subsequently exacerbates the pre-existing coronary artery disease resulting from increased platelet adhesiveness or pancreatic enzyme induced coagulopathy.…”

“…Keywords: acute pancreatitis, acute coronary syndrome, diagnosis A variety of ECG changes have been identified in association with acute pancreatitis such as bradycardia, arrhythmias, T-wave changes, STsegment elevation (Khan et al 2014) or depression and intraventricular conduction disturbances, but is rarely associated with corresponding cardiac enzyme derangements (Antonio et al 2017).…”