Elevated Hemi-diaphragms as a Cause of ST-segment Elevation: A case report and review of literature

Singh, Manmohan; Sood, Aditya; Rehman, Mobeen Ur; Othman, Mahmoud; Afonso, Luís

doi:10.1016/j.jelectrocard.2017.04.001

Cited by 9 publications

(12 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our case resembles the one described by Singh et al [7]. They postulated that increase in intra-abdominal pressure provoked external compression of the inferior epicardial arteries (right coronary and posterior descending arteries) with ST-segment elevation in the inferior leads but coronary arteries without obstructive lesions with resolution of the ST-elevation by decreasing intraabdominal pressure.…”

Section: Discussionsupporting

confidence: 85%

Cardiac extrinsic compression due to abdominal distension as a cause of electrocardiographic abnormality in a critically ill patient

Salvador-Casabón¹,

Pelegrín-Juana²,

Cantero-Lozano³

et al. 2020

J. Mol. Clin. Med.

View full text Add to dashboard Cite

Anomalies in the ST segment, especially ST-segment elevation, require the ruling out of possible etiologies such as myocardial ischemia or pericarditis. However, other noncardiac disorders such as increases in intra-abdominal and intrathoracic pressure, may cause ST-segment elevation as well and should be considered as possible etiologies due to the poor prognosis they imply in the clinical evolution of the patient. This is especially important in critically ill patients. In this respect, we herein present a case in which the increase in intra-abdominal pressure and thoracic cavity elevation due to gastric and intestinal distension, which was not present in the first CT, provoked a cardiac and coronary compression resulting in T-shaped dome wave, a QT prolongation and ST segment elevation in the inferior leads of the electrocardiogram, the patient did not present at the time of admission, ruling out other possible etiologies such as ionic imbalance or acute ischemia.

show abstract

Section: Discussionsupporting

confidence: 85%

Cardiac extrinsic compression due to abdominal distension as a cause of electrocardiographic abnormality in a critically ill patient

Salvador-Casabón¹,

Pelegrín-Juana²,

Cantero-Lozano³

et al. 2020

J. Mol. Clin. Med.

View full text Add to dashboard Cite

show abstract

“…8 Although ST elevation on ECG is a common finding in STEMI, it is important to note that ST elevation is not a pathognomonic sign as there are other conditions mimicking the ECG changes. [3][4][5][6][7] In the literature, there have been only two reported cases of gastric perforation mimicking STEMI (table 1). 9 10 In accordance with previous cases, our case was occurred in elderly male patient.…”

Section: Discussionmentioning

confidence: 99%

“…3 Moreover, it could also present in variety of abdominal conditions. [4][5][6][7] Nonetheless, report on gastric perforation that present with ST-segment elevation was still scarce to this date. In this report, we present a case of an elderly patient with acute peritonitis and pneumoperitoneum secondary to gastric perforation with dynamic ECG changes mimicking anteroseptal STEMI.…”

Section: Introductionmentioning

confidence: 99%

Gastric perforation mimicking ST-segment elevation myocardial infarction

Intan

Hasibuan²,

Gandi

et al. 2021

BMJ Case Rep

View full text Add to dashboard Cite

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.

show abstract

“…Depending on whether it surrounds the tip of the heart (providing the blood supply to the apical fourth of the left ventricular inferior wall-as seen in right anterior oblique angiographic view) or not, the LAD coronary artery qualifies as long (= dominant) or short (= non-dominant) [35]. Depending on whether the posterior descending artery (responsible for blood delivery to the inferior third of the interventricular septum, left ventricular inferior wall and the posteromedial papillary muscle) comes off the RCA or not, RCA is and intracranial haemorrhage; [1,11,20,29,30,31] 3) causes without life-threatening symptoms: secondary left ventricular hypertrophy (LVH), [2,6,11] left bundle branch block (LBBB), [6,11] non-specific intraventricular conduction disturbances, [12] ventricular pacing, [31] electrical cardioversion, [6,9,11] pectus excavatum, [32] heart compression either by hiatal hernia, [33] elevated left hemidiaphragm from an acute gastric distension, [23] or by ileus [34]. Beyond symptoms, all the single-cause ST elevations listed above can be ordered depending on their primary or secondary pattern, cardiac or non-cardiac cause, space extent, and time course (Table 1).…”

Section: Causes Of Pathologic St-segment Elevationmentioning

confidence: 99%

ST Segment Elevation

Lucaci¹

2022

Romanian Journal of Cardiology

View full text Add to dashboard Cite

As the earliest indirect sign of an acute coronary occlusion arriving against non-operative collateral heart vessels, the unabating ST segment elevation accounts for the acute coronary syndrome asking for mandatory and immediate reperfusion therapy. The geography of the ST segment elevations usually enables one to identify the culprit artery and to guess its likely occlusion site, as pivotal pieces of the necessary vital risk forecasting, along with somehow expected occurring arrhythmias. Aside from the classical ST segment elevation myocardial infarction (STEMI) pattern, a handful of distinctive non-ST elevation appearances of the acute coronary occlusion also need imperative reperfusion therapy, thus qualifying themselves as STEMI equivalents. The early forthcoming of ST elevation during an acute transmural ischaemic episode, as well as the wide availability of the electrocardiogram, make it an invaluable diagnostic tool. Yet many confounding factors are able to limit the diagnostic sensibility of ST elevation (as for example its customary absence in the conventional leads in some cases of circumflex artery occlusion, or the casual mutual cancellation of the transmural ST vectors from opposite ventricular walls), the accuracy of the electrocardiographic localisation of the occlusion site (due to coronary anatomic variants, concomitant new or old coronary lesions elsewhere, previous coronary artery bypass grafts), as well as its specificity for transmural ischaemia (by virtue of a well-known manifold of non-ischaemic causes). While the STEMI patient must be offered undelayed reperfusion therapy, the non-ischaemic ST elevation one should be kept away from the haemorrhagic risk of a useless invasive procedure.

show abstract

Elevated Hemi-diaphragms as a Cause of ST-segment Elevation: A case report and review of literature

Cited by 9 publications

References 8 publications

Cardiac extrinsic compression due to abdominal distension as a cause of electrocardiographic abnormality in a critically ill patient

Cardiac extrinsic compression due to abdominal distension as a cause of electrocardiographic abnormality in a critically ill patient

Gastric perforation mimicking ST-segment elevation myocardial infarction

ST Segment Elevation

Contact Info

Product

Resources

About