Agrawal Akanksha, Sayyida Nuzhat, Penalver Jorge Luis, Ziccardi Mary R
Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
Case Rep Cardiol. 2018 Oct 24;2018:9382904. doi: 10.1155/2018/9382904. eCollection 2018.
Electrocardiographic changes imitating myocardial ischemia have been occasionally reported in patients with intra-abdominal pathology including acute pancreatitis.
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.
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.
包括急性胰腺炎在内的腹腔内病变患者偶尔会出现类似心肌缺血的心电图改变。
一名60岁男性，无既往病史，在一次晕厥发作后到急诊科就诊。在急诊科，他的生命体征稳定。他的心电图显示窦性心动过缓，每分钟53次，T波高尖，II、III、aVF导联ST段抬高1毫米，V3导联ST段抬高2毫米，如图所示。由于担心ST段抬高型心肌梗死（STEMI），他紧急接受了左心导管检查（LHC），结果显示为非阻塞性冠状动脉疾病（CAD）。他的实验室检查结果显示脂肪酶为25304 IU/l（正常水平为8 - 78 IU/l）。他的肝功能检查和甘油三酯水平正常。肌钙蛋白<0.01 ng/ml。腹部计算机断层扫描检查显示急性间质性胰腺炎，钩突部有一小片离散的液体积聚。他接受了积极的静脉液体复苏治疗，并于第3天出院。
像急性胰腺炎这样的腹腔内病变可导致类似STEMI的短暂心电图改变。利用心电图线索、超声心动图检查结果和临床判断来避免心脏导管检查、造影剂暴露及相关医疗费用是很重要的。
