Images in cardiovascular medicine: pseudo-myocardial infarction.

Abstract

HomeCirculationVol. 101, No. 25Pseudo–Myocardial Infarction Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessOtherPDF/EPUBPseudo–Myocardial Infarction Szu-Chun Hung, Chern-En Chiang, Jen-Dar Chen and Philip Yu-An Ding Szu-Chun HungSzu-Chun Hung From the Division of Cardiology (C.-E.C., P.Y.-A.D.), Department of Medicine (S.-C.H., C.-E.C., P.Y.-A.D.), and Department of Radiology (J.-D.C.), Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan. Search for more papers by this author , Chern-En ChiangChern-En Chiang From the Division of Cardiology (C.-E.C., P.Y.-A.D.), Department of Medicine (S.-C.H., C.-E.C., P.Y.-A.D.), and Department of Radiology (J.-D.C.), Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan. Search for more papers by this author , Jen-Dar ChenJen-Dar Chen From the Division of Cardiology (C.-E.C., P.Y.-A.D.), Department of Medicine (S.-C.H., C.-E.C., P.Y.-A.D.), and Department of Radiology (J.-D.C.), Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan. Search for more papers by this author and Philip Yu-An DingPhilip Yu-An Ding From the Division of Cardiology (C.-E.C., P.Y.-A.D.), Department of Medicine (S.-C.H., C.-E.C., P.Y.-A.D.), and Department of Radiology (J.-D.C.), Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan. Search for more papers by this author Originally published27 Jun 2000https://doi.org/10.1161/01.CIR.101.25.2989Circulation. 2000;101:2989–2990A4 1-year-old man was admitted to the hospital because of severe lower sternal pain with diaphoresis for 1 hour. He had no history of peptic ulcer disease and denied smoking, alcohol abuse, and use of illicit drugs. An ECG (Figure 1) revealed ST-segment elevation of 2 mm and peaked upright T waves in leads V1 through V3, with reciprocal changes in lead II and inverted T waves in V4 through V6. Particular noteworthy were the bizarre T waves observed in the limb leads. Cardiac enzymes, liver function tests, and serum electrolytes, amylase, and lipase were within normal limits. A diagnosis of acute myocardial infarction was suspected. Thrombolytic therapy was considered but was rejected by the patient. Intravenous nitroglycerin, heparin, and β-blocker were administered but did not ameliorate his symptoms.An echocardiogram showed no wall motion abnormalities. Serial cardiac enzymes were normal. A contrast-enhanced CT scan (Figure 2) and MRI (Figure 3) of the abdomen 1 day after admission, however, disclosed diffuse swelling of the pancreas and associated mesenteric venous thrombosis (arrow, a low-density thrombus in the portal vein). A 3-fold elevation of serum lipase was noted on hospital day 5. The patient received nothing by mouth and was supported with intravenous fluids and adequate analgesia. Anticoagulation therapy was continued for his venous thrombosis. He recovered in 2 weeks, and there was gradual resolution of the ECG ST-segment elevation toward baseline and normalization of the T waves.ECG changes resembling acute myocardial infarction are a rare phenomenon in acute pancreatitis. The ECG changes probably reflect changes in the vagal nervous system. Visceral venous thrombosis is also a rare but potentially lethal complication of acute pancreatitis. The initial cardiovascular manifestations in this patient gave the misleading impression of acute myocardial infarction. The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.Download figureDownload PowerPointDownload figureDownload PowerPointDownload figureDownload PowerPointFootnotesCorrespondence to Chern-En Chiang, MD, PhD, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei 11217, Taiwan. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetails June 27, 2000Vol 101, Issue 25Article InformationMetrics Download: 296 Copyright © 2000 by American Heart Associationhttps://doi.org/10.1161/01.CIR.101.25.2989 Originally publishedJune 27, 2000 PDF download Advertisement