Escherichia coli septic shock masquerading as ST-segment elevation myocardial infarction
Juan D Martinez1, Rajesh V Babu, Gulshan Sharma
1Division of Allergy, Pulmonary, Immunology, Critical Care and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0561, USA.
Postgraduate Medicine
|April 1, 2009
Summary
Elevated troponin levels and ST-segment elevations in septic shock are rare but significant findings. This case highlights that these cardiac changes in sepsis do not always indicate acute coronary syndrome.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Elevated cardiac biomarkers, such as troponin I (TnI), and electrocardiographic (ECG) changes are crucial for diagnosing acute coronary syndrome (ACS).
- Elevated TnI can also be observed in sepsis, stemming from hypoperfusion or direct cardiac infection, and serves as a prognostic marker.
- ECG changes in sepsis are less understood, though Osborn waves and QT prolongation have been noted.
Observation:
- This report details a rare case of ST-segment elevations and elevated troponin levels in a 59-year-old woman experiencing Escherichia coli septic shock.
- Coronary angiography in this patient revealed no signs of acute coronary syndrome.
Findings:
- The patient presented with ST-segment elevations and elevated cardiac troponin levels, initially suggestive of ACS.
- Diagnostic workup, including coronary angiography, excluded ACS as the cause.
- The observed cardiac manifestations were attributed to septic shock.
Implications:
- This case underscores that ST-segment elevations and elevated troponin in the context of sepsis can mimic ACS but may arise from non-coronary causes.
- Recognizing these non-ACS causes of cardiac biomarker elevation and ECG changes in sepsis is vital for accurate diagnosis and management.
- Further research into the mechanisms and clinical significance of ECG changes in sepsis is warranted.
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