Electrocardiographic Abnormalities in Acute Pancreatitis: Two Patients Studied by Selective Coronary Arteriography

Spritzer, Harlan W.; Peterson, Charles R.; Jones, Robert C.; Overholt, Edwin L.

doi:10.1093/milmed/134.9.687

Cited by 11 publications

(5 citation statements)

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“…This stunning could be the result of transient coronary thrombosis or coronary vasospasm [ 17 ]. Angiographic findings in patients with pancreatitis and in patients with ST-segment elevation on ECG have shown normal coronaries in most cases [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Agrawal

Sayyida

Peñalver

et al. 2018

Case Reports in Cardiology

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Introduction Electrocardiographic changes imitating myocardial ischemia have been occasionally reported in patients with intra-abdominal pathology including acute pancreatitis. Case Report 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. Discussion 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.

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Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Agrawal

Sayyida

Peñalver

et al. 2018

Case Reports in Cardiology

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“…Whether pancreatitis may induce major ECG changes in the absence of cardiac pathology remains a subject of controversy (1,2,5,6,25,26). Rarely, ECG changes similar to myocardial infarction occur in patients with severe pancreatitis that progresses to hemodynamic collapse (1,10,11,20,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, ECG changes similar to myocardial infarction occur in patients with severe pancreatitis that progresses to hemodynamic collapse (1,10,11,20,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). The few previously reported cases of ECG changes suggestive of myocardial infarction in hemodynamically stable acute pancreatitis (Table 1) either lacked extensive cardiac investigations (ie, baseline ECG, echocardiography and coronary angiography) (1,5,6,25,36) or occurred in patients with underlying cardiac pathology (2,26). Our case is, therefore, unique in several regards: mild pancreatitis simulating an anterior myocardial infarction with a prior normal ECG ( Figure 4); normal echocardiographic and angiographic studies; and markedly pathological T wave inversions.…”

Section: Discussionmentioning

confidence: 99%

Pancreatitis with Electrocardiographic Changes Mimicking Acute Myocardial Infarction

Khairy

Marsolais

2001

Canadian Journal of Gastroenterology and Hepatology

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A 64-year-old woman with mild acute pancreatitis presented with epigastric pain, nausea and vomiting while undergoing hemodialysis for chronic renal insufficiency. Serial electrocardiograms revealed new onset ST segment elevations in leads V2 to V4 mimicking an anterior myocardial infarction, followed by diffusely inverted deep T waves. No cardiac pathology was demonstrated by echocardiography or coronary angiography. A review of the literature and possible pathophysiological mechanisms of electrocardiographic changes in acute pancreatitis, such as metabolic abnormalities, hemodynamic instability, vasopressors, pericarditis, myocarditis, a cardiobiliary reflex, exacerbation of underlying cardiac pathology, coagulopathy and coronary vasospasm, are discussed.

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“…Although ischemic ECG findings have been known to present in pancreatitis from the 1930s, these generally lacked 12-lead ECG data and standardized nomenclature [3, 4]. Since Bauerlein and Stobbe in 1954 [5], 36 instances of such mimicry have been noted, as shown in Table 1,Table 2, and Table 3 [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38] (clinical course, diagnostic testing, and patient outcome was not specified in one report and was omitted in the prevalence values for the respective categories). An inferior wall infarction pattern appears to be the most frequent (44.4%, or 16/36 cases).…”

Section: Reviewmentioning

confidence: 99%

Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

Lange

Broor

et al. 2019

Case Rep Gastroenterol

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A rare presentation of acute pancreatitis is with electrocardiographic (ECG) changes that mimic myocardial ischemia. We present a report of a patient that presented with hemodynamic instability and new ECG changes of ST segment elevations in contiguous leads II, III, and aVF mimicking an inferior wall myocardial infarction. Emergent coronary angiography showed no significant coronary obstruction, but it was followed by a left-sided hemiplegia with radiographic evidence of diffuse embolic stroke. The patient was later found to have an underlying diagnosis of pancreatitis. Additional history that later became available indicated a history of severe acute pancreatitis treated elsewhere a few months prior to the current admission. We present the first comprehensive review of the literature comprising 36 total cases with pancreatitis masquerading as acute myocardial infarction, with inferior wall STEMI pattern being the most frequent. We present this case to highlight the diagnostic dilemma posed by this masquerade of a high acuity myocardial infarction and to highlight alternative diagnoses to be considered in such clinical circumstances.

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Electrocardiographic Abnormalities in Acute Pancreatitis: Two Patients Studied by Selective Coronary Arteriography

Cited by 11 publications

References 0 publications

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Pancreatitis with Electrocardiographic Changes Mimicking Acute Myocardial Infarction

Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

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