Noncoronary disease simulating myocardial ischemia or infarction.

Abstract

Misinterpretation of the electrocardiogram can do our patients considerable harm when the changes result from benign physiologic stimuli 1 or represent merely unrecognized normal variants. 2 In another common situation, but one that is potentially much less serious, the misleading ECG pattern suggesting coronary disease results from pathologic changes that are noncardiac or at least noncoronary. In these circumstances disease is at least present even though of mistaken identity. The main danger to the patient in this event is that the pronouncement of ischemic heart disease, in mistake for another disease which may be curable or at least more reversible than coronary involvement, may prematurely end the diagnostic search. Numerous reversible noncardiac syndromes such as allergic reactions, vitamin deficiencies, anemia, hemorrhage, shock, lead poisoning, endocrine disorders, heat stroke, intracranial disease of both organic and psychic origin, infections, acute glomerulonephritis, electrolyte disturbances, abdominal disorders, and acute cor pulmonale can produce nonspecific