Acute pancreatitis presenting as acute inferior wall ST-segment elevations on electrocardiography

• Published in: The American journal of emergency medicine 2008-07, Vol.26 (6), p.734.e1-734.e4
• Main Authors: Makaryus, Amgad N., MD, Adedeji, Oluwatoyin, MD, Ali, Sayed K., MD
• Format: Article
• Language: English
• Subjects: Abdomen; Acute coronary syndromes; Acute Disease; Cardiovascular disease; Coronary vessels; Diagnosis, Differential; Electrocardiography; Emergency; Emergency medical care; Heart attacks; Hospitals; Humans; Hypertension; Intubation; Ischemia; Kidney transplantation; Kinases; Male; Middle Aged; Myocardial infarction; Myocardial Infarction - diagnosis; Pain management; Pancreatitis - diagnosis; Risk factors; Sinuses
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2007.11.008

Over recent years, much attention has been directed toward the optimal way to rule out acute coronary syndromes and myocardial infarction in patients presenting with chest pain. The electrocardiogram (ECG) is one of the single most important tools in this process. Acute pancreatitis has been shown to be associated with ECG changes that can mimic acute myocardial ischemia. These ECG changes, in association with the epigastric pain and the occasional hemodynamic instability found in acute pancreatitis, have frequently prompted invasive coronary evaluation and even thrombolytic therapy. We present a case of a man with multiple risk factors for coronary artery disease who presented with chest pressure and ECG changes suggesting an acute inferior wall myocardial infarction. He had an angiogram that revealed normal coronary arteries and, subsequently, was diagnosed with acute pancreatitis based on suggestive pancreatic enzymes and computed tomography of the abdomen.