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.
Insights
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.
Abstract:
Elevated cardiac biomarkers in conjunction with electrocardiographic (ECG) changes are valuable in diagnosing acute coronary syndrome (ACS). Elevated troponin I (TnI), while commonly seen in ACS, can also occur in entities such as sepsis and pulmonary thromboembolic disease. Raised TnI levels in patients with sepsis result from various mechanisms, including hypoperfusion or direct extension of infection to cardiac tissue, and can also serve as an important prognostic indicator. Electrocardiographic changes in sepsis are not as well described. Some of the ECG findings associated with septic shock include loss of QRS amplitude, increase in QTc interval, bundle branch blocks, and development of narrowed QRS intervals with deformed, positively deflected J waves (commonly known as Osborn waves). ST-segment elevations in sepsis are rare and have only previously been noted in a handful of case reports involving patients with septic shock. We present a case of a 59-year-old woman with ST-segment elevations and increased levels of cardiac troponin from Escherichia coli septic shock in the setting of normal coronary angiography.
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