Case Report:Escherichia coliSeptic Shock Masquerading as ST-Segment Elevation Myocardial Infarction

Abstract

Elevated cardiac biomarkers in conjunction with electrocardiographic (ECG) changes are valuable in diagnosing acute coronary syndrome (ACS). Elevated troponin I (TnI), while commonly seen in ACS, can also occur in entities such as sepsis and pulmonary thromboembolic disease. Raised TnI levels in patients with sepsis result from various mechanisms, including hypoperfusion or direct extension of infection to cardiac tissue, and can also serve as an important prognostic indicator. Electrocardiographic changes in sepsis are not as well described. Some of the ECG findings associated with septic shock include loss of QRS amplitude, increase in QTc interval, bundle branch blocks, and development of narrowed QRS intervals with deformed, positively deflected J waves (commonly known as Osborn waves). ST-segment elevations in sepsis are rare and have only previously been noted in a handful of case reports involving patients with septic shock. We present a case of a 59-year-old woman with ST-segment elevations and increased levels of cardiac troponin from Escherichia coli septic shock in the setting of normal coronary angiography.

Electrocardiographic Changes in a Patient With Pulmonary Embolism and Septic Shock

“…Precordial ST segment elevation has been previously described in patients with extensive PE 2)3). However, similar ECG manifestations have been described in patients with severe sepsis and normal coronary arteries 4)5). In our patient, despite the absence of RWMA and significant enzyme increase, acute coronary syndrome, coronary vasospasm and acute myocarditis constituted the differential diagnoses, as coronary angiography and endomyocardial biopsy were not readily available.…”

Pathophysiology of sepsis-induced myocardial dysfunction

“…However, it was also reported that ST-segment elevations were rare in septic shock patients in the setting of normal coronary angiography. In addition, the electrocardiographic changes during septic shock also include a loss of QRS amplitude, increase in QT interval, development of narrowed QRS intervals with deformed bundle branch blocks [ 34 ] and new-onset atrial fibrillation, especially in older septic shock patients [ 35 ].…”

Sepsis-induced Cardiomyopathy

“…The SIMD can be accompanied by specific changes in the electrocardiogram (ECG), which can be very similar to those occurring during acute coronary syndromes [22], including ST segment depression or elevation, Q wave appearance, new left bundle branch block, peaked T wave, lenghtening of the QTc interval or positively J waves (Osborn wave) appearance [144]. The ECG may suffer temporary modifications, with an initial predominance of ST segment elevation followed by appearance of a Q wave.…”