Dramatic Electrocardiographic T-Wave Changes Associated with Gastric Dilatation

Frais, Michael A.; Rodgers, K

doi:10.1378/chest.98.2.489

Cited by 17 publications

(13 citation statements)

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“…Dramatic electrocardiographic T-wave changes with gastric dilatation without any evidence of coronary artery disease have been reported [8]. One case report of an adolescent male following trauma illustrated the need to consider acute gastric distention in the differential diagnosis of acute ST segment elevations in the ECG [9].…”

Section: Discussionmentioning

confidence: 99%

“…ST elevation Myocardial infarction (STEMI) is a medical emergency, since the beneficial effects of therapy with reperfusion are greatest when performed early. But a variety of noncardiac conditions have been known to mimic the ECG changes seen ACS including cholecystitis [1–4], pancreatitis [5, 6], pneumonia [7], gastric distention [8, 9], acute stroke, subarachnoid hemorrhage [10], pericarditis, neoplastic invasion of the myocardium, acute pulmonary embolism, and hypothermia. Here we present a male patient presenting with acute partial intestinal obstruction causing gastric distension and intestinal dilatation with dynamic ECG changes mimicking anterior STEMI.…”

Section: Introductionmentioning

confidence: 99%

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Gastric dilatation and intestinal obstruction mimicking acute coronary syndrome with dynamic electrocardiographic changes

Herath

Matthias

Keragala

et al. 2016

BMC Cardiovasc Disord

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BackgroundST elevation myocardial infarction is a medical emergency and the electrocardiogram is a part of the mainstay in the initial diagnosis. A variety of non-cardiac conditions have been known to mimic the electrocardiographic changes seen in acute coronary syndrome. We present a patient presenting with acute partial intestinal obstruction causing gastric distension and intestinal dilatation who also had dynamic electrocardiographic changes, mimicking anterior ST elevation myocardial infarction. Only very few cases of gastric distention and intestinal dilatation leading to acute ST segment elevation in electrocardiogram are reported so far in literature.Case presentationA fifty-six-year-old Sri Lankan male, without any modifiable risk factors for ischemic heart disease presented with acute onset nausea, vomiting, sweating, abdominal discomfort and fullness without any chest pain. On examination, he had a pulse rate of 50 beats per minute and his blood pressure was 110/50 mmHg. His abdomen was distended and the liver dullness was not detectable. Subsequent ECG showed > 2 mm ST elevations with T inversions in chest leads V1 to V3, J point elevation in leads L 11, L 111, aVF and T inversion in leads L 1 and aVL. Cardiac biomarkers were normal and 2D echo showed normal left ventricular function without any regional wall motion abnormalities. Abdominal X-ray showed a distended stomach, dilated ascending and descending colon with absent rectal air. Electrocardiographic changes reverted back to normal with the resolution of bowel obstruction.ConclusionThe mechanism of ECG changes in such a case like this is yet to be elucidated, but can be postulated to happen due to change in the position of the heart in the thoracic cavity causing change in the cardiac axis. This case emphasizes the importance of a proper history and highlights the value of auxiliary investigations such as cardiac biomarkers and echocardiogram in the diagnosis of acute coronary syndrome in a confusing situation such as this. This also illustrates the importance of early recognition of other noncardiac causes like acute gastric distention as being responsible for dynamic ECG changes. This will obviate a myriad of unnecessary investigations, interventions, costly management strategies and patient anxiety.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gastric dilatation and intestinal obstruction mimicking acute coronary syndrome with dynamic electrocardiographic changes

Herath

Matthias

Keragala

et al. 2016

BMC Cardiovasc Disord

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“…The ECG abnormalities due to extra cardiac systemic disease such as an acute pulmonary embolism, central nervous system disease (intracranial haemorrhage, trauma, increased intracranial pressure and ischaemic stroke), aortic dissection and pneumothorax had been well described 1 . Abdominal pain aetiologies such as acute cholecystitis, pancreatitis and gastric distension associated with transient electrocardiographic changes are consistent with myocardial ischaemia 2–4 . These changes are T‐wave inversion or ST segment depression mostly; however, few cases with ST segment elevation due to acute cholecystitis have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Severe trauma (ST) segment and T-wave abnormalities suggesting acute coronary ischaemia have been reported in patients with a variety of systemic disorders and abdominal emergencies. [1][2][3][4] Patients with acute cholecystitis rarely present dynamic T-wave abnormalities; however, the incidence or exact mechanism of such ECG changes is unknown. Here, we report a 42-year-old man with acute cholecystitis that developed dynamic ECG changes mimicking acute coronary syndrome.…”

Section: Introductionmentioning

confidence: 99%

Acute coronary syndrome mimicked by acute cholecystitis

Aksay¹,

Ersel²,

Kıyan³

et al. 2010

Emerg Medicine Australasia

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Various aetiologies have been reported that cause severe trauma segment and T-wave abnormalities that are not related to acute coronary syndromes. However, the reports of transient ECG abnormalities associated with acute cholecystitis are limited in the literature. We describe a 42-year-old man presented with abdominal pain and hypertensive episode that developed dynamic ECG changes mimicking acute coronary syndrome and was diagnosed acute cholecystitis eventually. Emergency physicians should keep in mind dynamic T-wave changes mimicking acute myocardial ischaemia in patients with acute cholecystitis.

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“…15 Usually these conditions lead to diffuse ECG changes, such as nonspecific T-wave inversions or ST-segment depressions. 6–10 Although chest pain with ST-segment elevation frequently indicates cardiac ischemia, it has also been reported with gastric distension, 16 acute cholecystitis, 1–3 pericarditits, 4 neoplastic invasion of the myocardium, 4 acute cor pulmonale, 4 and hypothermia. 4 Awareness of these differentials is crucial to ensuring appropriate diagnostic investigations, and early confirmation of the alternative diagnoses.…”

Section: Introductionmentioning

confidence: 99%