Elevated Hemi-diaphragms as a Cause of ST-segment Elevation: A case report and review of literature
Manmohan Singh1, Aditya Sood2, Mobeen Ur Rehman2
1Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, MI.
Insights
ST-segment elevation (STE) on ECG, typically indicating heart issues, can rarely stem from gastrointestinal problems. This case shows extreme abdominal distension causing STE, which resolved upon relief, highlighting non-cardiac causes.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Diagnostics
Background:
- ST-segment elevation (STE) on electrocardiogram (ECG) usually signifies acute myocardial infarction or pericarditis.
- Non-cardiac etiologies of STE are infrequently documented, particularly those originating from gastrointestinal disorders.
Observation:
- A patient presented with STE on ECG.
- The STE was associated with extreme abdominal distension and elevated hemi-diaphragm.
- This led to extrinsic cardiac and epicardial coronary compression.
Findings:
- The observed STE was directly linked to mechanical compression caused by abdominal distension.
- Resolution of abdominal distension led to the complete resolution of STE.
- This case demonstrates a rare, non-coronary cause of STE.
Implications:
- Clinicians should consider gastrointestinal etiologies in the differential diagnosis of STE, especially when cardiac causes are not evident.
- Abdominal distension can mimic acute cardiac events, necessitating a thorough patient history and physical examination.
- Recognizing non-cardiac causes of STE can prevent unnecessary cardiac interventions and guide appropriate treatment.
Abstract:
While ST-segment elevation (STE) on ECG is widely recognized as representing myocardial infarction or injury such as coronary occlusion or pericarditis, STE may occasionally ensue from non-cardiac etiologies. Indeed, gastrointestinal disorders causing STE are not well documented in the literature. We present a case wherein extreme abdominal distension and hemi-diaphragm elevation resulted in extrinsic cardiac and epicardial coronary compression manifesting as STE. Subsequent relief of the abdominal distension resulted in resolution of STE representing a noncoronary cause of STE. A brief literature review, illustrating the importance of considering abdominal etiologies as a cause of STE is provided.
