(Circulation. 2000;101:2989.)
© 2000 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Pseudo–Myocardial Infarction
From the Division of Cardiology (C.-E.C., P.Y.-A.D.), Department of Medicine (S.-C.H., C.-E.C., P.Y.-A.D.), and Department of Radiology (J.-D.C.), Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Correspondence to Chern-En Chiang, MD, PhD, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei 11217, Taiwan. E-mail cechiang{at}vghtpe.gov.tw
A4 1-year-old man
was admitted to the hospital because of severe lower sternal pain with
diaphoresis for 1 hour. He had no history of peptic ulcer disease and
denied smoking, alcohol abuse, and use of illicit drugs. An ECG (Figure 1
) revealed ST-segment elevation of
2 mm and peaked upright T waves in leads V1
through V3, with reciprocal changes in lead II
and inverted T waves in V4 through
V6. Particular noteworthy were the bizarre T
waves observed in the limb leads. Cardiac enzymes, liver function
tests, and serum electrolytes, amylase, and lipase were within normal
limits. A diagnosis of acute myocardial infarction was suspected.
Thrombolytic therapy was considered but was rejected by the
patient. Intravenous nitroglycerin,
heparin, and ß-blocker were administered but did not ameliorate his
symptoms.
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An echocardiogram showed no wall
motion abnormalities. Serial cardiac enzymes were normal. A
contrast-enhanced CT scan (Figure 2) and
MRI (Figure 3) of the abdomen 1 day after
admission, however, disclosed diffuse swelling of the pancreas and
associated mesenteric venous thrombosis (arrow, a low-density thrombus
in the portal vein). A 3-fold elevation of serum lipase was noted
on hospital day 5. The patient received nothing by mouth and was
supported with intravenous fluids and adequate analgesia.
Anticoagulation therapy was continued for his venous thrombosis. He
recovered in 2 weeks, and there was gradual resolution of the ECG
ST-segment elevation toward baseline and normalization of the T
waves.
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ECG changes resembling acute myocardial infarction are a rare phenomenon in acute pancreatitis. The ECG changes probably reflect changes in the vagal nervous system. Visceral venous thrombosis is also a rare but potentially lethal complication of acute pancreatitis. The initial cardiovascular manifestations in this patient gave the misleading impression of acute myocardial infarction.
Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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