Transient ST-segment elevation during acute pancreatitis

El-Khabiry, Ehab; Omar, Hesham R.; Camporesi, Enrico M.

doi:10.1016/j.ejim.2016.02.008

Cited by 4 publications

(3 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most likely cause of these abnormalities was electrolyte disturbances [ 5 ]. There are few case reports describing STEMI as a complication of acute pancreatitis [ 7 ], and there are rare reports of STEMI-like ECG changes in a patient with acute pancreatitis without ACS [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Agrawal

Sayyida

Peñalver

et al. 2018

Case Reports in Cardiology

View full text Add to dashboard Cite

Introduction Electrocardiographic changes imitating myocardial ischemia have been occasionally reported in patients with intra-abdominal pathology including acute pancreatitis. Case Report A 60-year-old man with no past medical history presented to the emergency department (ED) after a syncopal episode. In ED, his vitals were stable. His ECG showed sinus bradycardia at 53 beats per minute, peaked T waves, 1 mm ST-segment elevation in leads II, III, and aVF, and 2 mm ST elevation in V3 as shown in the figures. With the concern for STEMI, he was taken for left heart catheterization (LHC) emergently, showing nonobstructive coronary artery disease (CAD). His laboratory workup was remarkable for lipase of 25,304 IU/l (normal level 8–78 IU/l). His liver function test and triglyceride level were normal. Troponin was <0.01 ng/ml. A computed tomographic exam of the abdomen revealed acute interstitial pancreatitis with a small discrete fluid collection in the uncinate process. He was treated with aggressive intravenous fluid resuscitation and was discharged on day 3. Discussion Intra-abdominal pathologies like acute pancreatitis can lead to transient ECG changes mimicking STEMI. It is important to use ECG clues, echocardiographic findings, and clinical judgement to avoid cardiac catheterization, contrast exposure, and associated health care costs.

show abstract

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Agrawal

Sayyida

Peñalver

et al. 2018

Case Reports in Cardiology

View full text Add to dashboard Cite

show abstract

“…Although ischemic ECG findings have been known to present in pancreatitis from the 1930s, these generally lacked 12-lead ECG data and standardized nomenclature [3, 4]. Since Bauerlein and Stobbe in 1954 [5], 36 instances of such mimicry have been noted, as shown in Table 1,Table 2, and Table 3 [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38] (clinical course, diagnostic testing, and patient outcome was not specified in one report and was omitted in the prevalence values for the respective categories). An inferior wall infarction pattern appears to be the most frequent (44.4%, or 16/36 cases).…”

Section: Reviewmentioning

confidence: 99%

Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

Lange

Broor

et al. 2019

Case Rep Gastroenterol

View full text Add to dashboard Cite

A rare presentation of acute pancreatitis is with electrocardiographic (ECG) changes that mimic myocardial ischemia. We present a report of a patient that presented with hemodynamic instability and new ECG changes of ST segment elevations in contiguous leads II, III, and aVF mimicking an inferior wall myocardial infarction. Emergent coronary angiography showed no significant coronary obstruction, but it was followed by a left-sided hemiplegia with radiographic evidence of diffuse embolic stroke. The patient was later found to have an underlying diagnosis of pancreatitis. Additional history that later became available indicated a history of severe acute pancreatitis treated elsewhere a few months prior to the current admission. We present the first comprehensive review of the literature comprising 36 total cases with pancreatitis masquerading as acute myocardial infarction, with inferior wall STEMI pattern being the most frequent. We present this case to highlight the diagnostic dilemma posed by this masquerade of a high acuity myocardial infarction and to highlight alternative diagnoses to be considered in such clinical circumstances.

show abstract

“…Acute abdomen, including acute pancreatitis, can often be accompanied by various ECG changes, such as arrhythmias, dynamic T waves, pathologic Q waves and ST segment elevation, although the underlying mechanisms remain unknown ( 1 ). ST segment elevation is often transient and returns to normal after the acute condition is stabilized, which does not indicate AMI ( 2 , 3 ). Although acute pancreatitis and concomitant myocardial infarction are uncommon in patients, we should be vigilant when patients with acute pancreatitis experience ST segment elevation in ECG because it often results in a poor prognosis and requires urgent treatment.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Abnormal ECG in a Patient With Acute Pancreatitis

Long

Tang

Wang

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Background: Both acute pancreatitis and acute myocardial infarction (AMI) are rapidly progressive and frequently fatal diseases that can be interrelated and lead to a vicious cycle for further problems. The concomitant occurrence of AMI and acute pancreatitis is rare but critical, and efficient diagnosis and treatment of such patients are challenging.Case Summary: We reported an uncommon case of abnormal ECG findings in a 63-year-old woman with acute pancreatitis. The patient exhibited increased biomarkers of myocardial injury, such as creatine kinase-MB (CK-MB) and troponin T, as well as ST segment elevation in inferior leads II, III, and aVF. Both of these have been previously observed in patients with acute abdomen in the absence of ST-segment elevation myocardial infarction (STEMI), including pancreatitis. In addition, lacking complaints of chest pain or tightness was also supportive of this idea. Echocardiography indicated abnormalities in the functioning of the left inferior posterior wall segments and decreased overall systolic function of the left ventricle with a 51% ejection fraction. Eventually, AMI was diagnosed after coronary computed tomography angiography (CCTA) showing critical stenosis of the right coronary artery and left anterior descending artery segments. The patient was urgently transferred to intensive care unit and was treated with anticoagulation, antiplatelet aggregation, lipid-lowering and other palliative drugs.Conclusion: Concomitant acute pancreatitis and AMI are often considered to be critical conditions with a poor prognosis. Therefore, it is important to rapidly identify this condition and consider transferring patients for multidisciplinary supportive care.

show abstract

Transient ST-segment elevation during acute pancreatitis

Cited by 4 publications

References 3 publications

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

Case Report: Abnormal ECG in a Patient With Acute Pancreatitis

Contact Info

Product

Resources

About