Intan Ryan Enast, Hasibuan Fani Suslina, Gandi Parama, Alkaff Firas F
Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia.
Department of Cardiology and Vascular Medicine, Dr. R. Koesma General Hospital, Tuban, Indonesia.
BMJ Case Rep. 2021 Mar 9;14(3):e237470. doi: 10.1136/bcr-2020-237470.
ST-elevation myocardial infarction (STEMI) is one of the medical emergencies in cardiology with high morbidity and mortality rate which requires rapid response. In elderly patients, its presenting symptoms may be atypical which may cause the diagnosis of MI to be delayed or missed. Therefore, ST-segment elevation on ECG has become the main instrument for initial diagnosis. However, there are a variety of conditions mimicking the ECG changes of STEMI. We report a case of 70-year-old patient with acute peritonitis and pneumoperitoneum secondary to gastric perforation with dynamic ECG changes mimicking anteroseptal STEMI. After the surgery, the ECG dynamically reverted to normal. He was then discharged after 4 days without any remaining symptoms. Misinterpretation of ECG findings may lead to unnecessary aggressive intervention, costly management strategies and delay in appropriate treatment.
ST段抬高型心肌梗死（STEMI）是心脏病学中的医疗急症之一，发病率和死亡率高，需要迅速做出反应。在老年患者中，其呈现的症状可能不典型，这可能导致心肌梗死的诊断延迟或漏诊。因此，心电图上的ST段抬高已成为初步诊断的主要依据。然而，有多种情况可模拟STEMI的心电图变化。我们报告一例70岁患者，因胃穿孔继发急性腹膜炎和气腹，动态心电图变化模拟前间壁STEMI。手术后，心电图动态恢复正常。4天后他出院，无任何残留症状。对心电图结果的错误解读可能导致不必要的积极干预、昂贵的管理策略以及适当治疗的延迟。
