MacKay Medical College, New Taipei City, Taiwan.
Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
Medicine (Baltimore). 2024 Feb 16;103(7):e37245. doi: 10.1097/MD.0000000000037245.
Although electrocardiographic changes have been previously reported in patients with acute pancreatitis, diffuse ST-segment elevation without occluded coronary arteries is rarely documented.
A 45-year-old man presented to our emergency department due to persistent epigastric pain for 2 hours. However, ECG in the emergency department revealed regular sinus rhythm at 67 beats per minute, peaked T waves in lead V3-5, and upsloping ST-segment elevation in leads II, III, aVF, and V2-6.
He was diagnosed with acute pancreatitis and presented with diffuse ST-segment elevation.
Laboratory workup and computed tomography supported the diagnosis of acute gallstone pancreatitis and endoscopic retrograde cholangiopancreatography was performed. Coronary angiography showed patent coronary arteries finally.
Endoscopic retrograde cholangiopancreatography and endoscopic papillo-sphincterotomy were performed, and the stone in the common bile duct was removed smoothly without immediate complication. Due to his relatively stable condition, he was discharged on day 7 of admission.
We presented an uncommon case of acute pancreatitis demonstrating similar features of AMI. This reminds cardiologists and emergency physicians to make the judgment with more caution to avoid jumping to conclusions and providing inappropriate treatment.
尽管先前有报道称急性胰腺炎患者存在心电图改变,但很少有记录显示无阻塞性冠状动脉的弥漫性 ST 段抬高。
一名 45 岁男性因持续 2 小时的上腹痛到我院急诊科就诊。然而,在急诊科的心电图显示规则窦性心律,心率为 67 次/分,V3-5 导联的尖峰 T 波,以及 II、III、aVF 和 V2-6 导联的上斜型 ST 段抬高。
他被诊断为急性胰腺炎,表现为弥漫性 ST 段抬高。
实验室检查和计算机断层扫描支持急性胆石性胰腺炎的诊断,并进行了内镜逆行胰胆管造影。冠状动脉造影最终显示冠状动脉通畅。
进行了内镜逆行胰胆管造影和内镜乳头括约肌切开术,胆总管内的结石顺利取出,无即刻并发症。由于他的病情相对稳定,他在入院第 7 天出院。
我们报告了一例不常见的急性胰腺炎病例,表现出类似急性心肌梗死的特征。这提醒心脏病专家和急诊医生更谨慎地做出判断,以避免草率下结论和提供不适当的治疗。