Dynamic ST-Segment Abnormality
Elias B Hanna1, Paul A LeLorier1, D Luke Glancy1
1Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center and University Medical Center New Orleans, New Orleans, Louisiana.
The American Journal of Cardiology
|December 2, 2017
Summary
Chest pain can mimic heart attack due to Wolff-Parkinson-White syndrome. This condition causes intermittent ventricular pre-excitation, leading to ECG changes that can be mistaken for myocardial infarction.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Intermittent chest pain is a common presenting complaint in emergency departments.
- Electrocardiogram (ECG) interpretation is critical for diagnosing acute cardiac events, particularly ST-segment elevation myocardial infarction (STEMI).
Observation:
- A 37-year-old male presented with chest pain, and initial ECG showed sinus rhythm with left atrial/ventricular enlargement and early repolarization.
- A subsequent ECG revealed significant ST-segment elevation and upright T waves in anterior leads, mimicking STEMI.
- The patient's symptoms and ECG changes were ultimately attributed to intermittent ventricular pre-excitation characteristic of Wolff-Parkinson-White (WPW) syndrome.
Findings:
- The ECG findings suggestive of myocardial infarction were a false positive.
- No electrocardiographic, echocardiographic, or serum markers of myocardial infarction were identified.
- The critical finding was intermittent ventricular pre-excitation due to WPW syndrome.
Implications:
- This case highlights the importance of careful ECG review to differentiate WPW-related changes from acute myocardial infarction.
- Misdiagnosis can lead to unnecessary activation of cardiac catheterization teams and invasive procedures.
- Awareness of WPW syndrome's ECG manifestations is crucial for accurate diagnosis and appropriate patient management.
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