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VOLUME 1 , ISSUE 3 ( September-December, 2023 ) > List of Articles

CASE REPORT

Acute Pancreatitis Masquerading as ST-elevation Myocardial Infarction (STEMI)

Moin Pandith, Kushagra Mathur, Shafat Kenu

Keywords : Acute chest pain, Acute MI, Acute pancreatitis, Case report, Chest pain, STEMI

Citation Information : Pandith M, Mathur K, Kenu S. Acute Pancreatitis Masquerading as ST-elevation Myocardial Infarction (STEMI). 2023; 1 (3):77-79.

DOI: 10.5005/njem-11015-0019

License: CC BY-NC 4.0

Published Online: 25-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: Various non-cardiac conditions had been known to mimic electrocardiographic changes seen in acute myocardial Ischaemia or infarction. However, the electrocardiographic changes mimicking ST-elevation myocardial ischaemia (STEMI) in acute pancreatitis (AP) have been occasionally reported and is rare. Case description: A 63-year-old male with no comorbidities or past medical illness presented to the emergency department (ED) with complaints of sudden onset of severe epigastric and retrosternal chest pain. In the ED, vitals were stable. ECG revealed ST-elevation in leads II, III, and aVF consistent with acute inferior wall MI. Bedside 2D electrocardiography was unremarkable. A point of care troponin-T test was done which came out to be negative. Laboratory workup revealed high levels of serum amylase (353 U/L) and serum lipase (1681 U/L) consistent with AP. Further, abdominal CT scan was done which confirmed changes consistent with acute inflammatory non-necrotising pancreatitis, thus confirming the diagnosis. Cardiac marker tests were negative and the patient was managed conservatively and discharged after 2 days in a stable condition with follow-up advice from gastroenterology team. Discussion: A variety of non-cardiac abdominal pathologies like AP can mimic electrocardiographic findings suggestive of acute myocardial ischaemia. However, even with high sensitivity, ECG can have false-positive ST-T changes. It mandates a thorough history, clinical examination, and comprehensive investigation to establish a diagnosis and make a proper disposal from ED.


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