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Pseudo myocardial infarction.

G N Cattermole1, N McKay

  • 1Emergency Unit, University Hospital of Wales, Cardiff, UK. cattermole@doctors.org.uk

Emergency Medicine Journal : EMJ
|July 22, 2006
PubMed
Summary
This summary is machine-generated.

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A rectus sheath hematoma, a rare cause of abdominal pain, can mimic acute myocardial infarction on electrocardiograms (ECGs). This case highlights the importance of considering non-cardiac causes for ECG changes, especially in patients with chronic obstructive pulmonary disease.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Pulmonology

Background:

  • A 66-year-old woman with chronic obstructive pulmonary disease (COPD) and a history of deep vein thrombosis (DVT) presented with severe abdominal pain.
  • She was on warfarin for DVT prophylaxis, with a recorded International Normalized Ratio (INR) of 7.7.

Observation:

  • The patient developed severe abdominal pain after coughing, later diagnosed with a rectus sheath hematoma.
  • A routine electrocardiogram (ECG) showed ST elevation, suggestive of acute inferior myocardial infarction.
  • Serial ECGs and troponin levels did not confirm acute myocardial infarction, despite persistent ECG abnormalities.

Findings:

  • The rectus sheath hematoma was identified as the cause of abdominal pain.
  • ECG findings mimicked acute myocardial infarction, a phenomenon not previously reported in conjunction with rectus sheath hematoma.

Related Experiment Videos

  • Negative troponin levels ruled out myocardial infarction.

    • Implications:

    • This case underscores the potential for non-cardiac conditions to cause "pseudo myocardial infarction" patterns on ECGs.
    • It emphasizes the critical need to correlate ECG findings with clinical presentation and laboratory results.
    • Treating the underlying condition, rather than solely relying on ECG interpretation, is crucial for patient management.