Inferolateral ST-segment elevation associated with a gastric variceal bleed and the use of a Minnesota tube

Abstract

The use of Minnesota and modified Sengstaken-Blakemore tubes for balloon tamponade in acute variceal haemorrhage has declined with the availability of modern endoscopic techniques. However, in massive uncontrolled haemorrhage their use may still be required. They are very effective in controlling acute bleeding, but are associated with a range of potentially serious complications. This case demonstrates an unusual complication of the use of a Minnesota tube in a gentleman with a large gastric variceal bleed. The patient developed inferolateral ST-segment elevation on a 12-lead ECG which resolved rapidly following aspiration of 2000 mL of blood from the gastric port of the Minnesota tube. It was thought that the distension of the stomach, along with the traction applied to the Minnesota tube, resulted in external compression of the diaphragmatic surface of the heart and the observed ECG changes.

Osteomyelitis of the Cervical Spine Presenting as Acute ST-Segment Elevation

“…To our knowledge, this is the first report of acute STE associated with anterior cervical abscess. Local compression (with possible irritation) of the pericardium has been postulated as a cause of STE in cases of hiatal hernia [7] and esophageal balloon tamponade [8]. In our patient, neither echocardiogram nor MRI neck showed any clear pericardial fluid or inflammation, but local irritation nevertheless seems a possible cause.…”

Inferolateral ST-segment elevation with use of Sengstaken-Blakemore tube for variceal bleeding during orthotopic liver transplantation

“…ST-segment changes associated with the use of SBT have previously been described in a case report in which STE was thought to have occurred due to external compression of the heart from a combination of gastric distension and traction applied to the SBT 4. In this case report, gastric distension had resulted from accumulation of gastric blood that, once aspirated, led to rapid resolution of the ST changes with only a small rise in troponin.…”

“…SBT are associated with major adverse events in up to 60% of patients including aspiration pneumonia and oesophageal rupture,2 yet they remain highly effective in controlling variceal haemorrhage 3. Oesophageal balloon tamponade tubes are thought to be a rare cause of ST-segment elevation (STE) 4. A recent alternative to SBT includes self-expandable, oesophageal metal stents which have shown efficacy in controlling bleeding from oesophageal varices 2 5…”

ST elevation in a patient with small bowel occlusion and gastric distension—What is the most likely explanation? A hypothesis generating case report

“…ST elevation has been previously described in cases of gastric distention and bowel occlusion (1)(2)(3). The proposed explanations for the ST elevation included coronary vasospasm in response to pain and/or abdominal distension, stress cardiomyopathy, myocardial ischaemia due to mechanical compression of the circumflex artery caused by gastric distension (2), and epicardial stretch caused by diaphragmatic contractions synchronous with cardiac systole (3).…”