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Massive ST-segment elevation without myocardial injury in a patient with fulminant hepatic failure and cerebral edema
1Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine.
Insights
Fulminant hepatic failure can cause ST-segment elevation on ECG, mimicking heart injury. This ECG finding in liver failure patients should not lead to unnecessary cardiac treatment or affect liver transplant eligibility.
Area of Science:
- Cardiology
- Hepatology
- Critical Care Medicine
Background:
- Fulminant hepatic failure (FHF) is a rare but life-threatening condition characterized by rapid liver damage.
- Electrocardiogram (ECG) abnormalities, including ST-segment elevation, can occur in critically ill patients, sometimes mimicking acute myocardial infarction.
- The clinical significance of ST-segment elevation in the context of FHF is not well-established and can complicate patient management.
Observation:
- A 49-year-old woman with FHF presented with significant ST-segment elevation on ECG.
- This ECG finding suggested diffuse myocardial injury.
- Subsequent investigations, including echocardiography and autopsy, revealed no cardiac abnormalities.
Findings:
- The ST-segment elevation observed was not indicative of actual cardiac pathology.
- No physiological, anatomical, or histological evidence of myocardial injury was found.
- Creatine phosphokinase levels did not support cardiac damage.
Implications:
- ST-segment elevation in the context of fulminant hepatic failure should not be presumed to be cardiac in origin.
- Such ECG findings should not lead to unnecessary cardiac interventions.
- Patient eligibility for liver transplantation should not be negatively impacted by these transient ECG changes.
Abstract:
A 49-year-old woman presented in fulminant hepatic failure. The ECG showed dramatic ST-segment elevation, suggesting diffuse myocardial injury. However, echocardiography, creatine phosphokinase enzyme determinations, and examination of the heart at autopsy (six days later) failed to demonstrate any physiologic, anatomic, or histologic evidence of abnormality. The appearance of ST-segment elevation in this setting should not prompt treatment for cardiac disease or limit the candidacy for liver transplantation of such critically ill patients.