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 abnormali-ties on echocardiography and patent coronary arteries. CASE PRESENTATIoN A 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 myo-cardial 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 des-cending artery (40% to 50%) and right coronary artery (20% to 30%) (Figures 1B and 1C). The left circumflex artery was small in size, sup-plied 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 dem-onstrated resolution of the ST-segment elevation (Figure 3).