Acute pancreatitis mimicking myocardial infarction: evaluation with myocardial contrast echocardiography

Acute pancreatitis has frequently been reported to be associated with transient electrocardiography changes mimicking myocardial infarction despite normal epicardial coronary arteries. Although these reports generally have not included simultaneous assessment of myocardial function, 1 previous report has documented suggestive electrocardiography changes associated with a transient regional wall-motion abnormality but normal epicardial coronary arteries. Although the origin of these findings is poorly understood, suggested mechanisms have included electrolyte abnormalities, a vagally mediated reflex, coronary vasospasm, and myonecrosis as a result of the release of pancreatic proteolytic enzymes. We report a case of acute pancreatitis with electrocardiography changes and a regional wall-motion abnormality despite normal epicardial coronary arteries. Myocardial contrast echocardiography performed in this patient to evaluate the coronary microcirculation allows further insight into the mechanism of these findings.