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Gastric perforation mimicking ST-segment elevation myocardial infarction
Ryan Enast Intan1,2, Fani Suslina Hasibuan2, Parama Gandi3
1Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia.
Insights
ST-elevation myocardial infarction (STEMI) can present atypically in elderly patients. This case highlights how gastric perforation mimicking STEMI on ECG can lead to misdiagnosis and delayed treatment.
Area of Science:
- Cardiology
- Emergency Medicine
- Gastroenterology
Background:
- ST-elevation myocardial infarction (STEMI) is a critical cardiac emergency with significant mortality.
- Elderly patients often exhibit atypical STEMI symptoms, complicating diagnosis.
- Electrocardiogram (ECG) ST-segment elevation is crucial for initial STEMI diagnosis but can be mimicked by other conditions.
Abstract:
ST-elevation myocardial infarction (STEMI) is one of the medical emergencies in cardiology with high morbidity and mortality rate which requires rapid response. In elderly patients, its presenting symptoms may be atypical which may cause the diagnosis of MI to be delayed or missed. Therefore, ST-segment elevation on ECG has become the main instrument for initial diagnosis. However, there are a variety of conditions mimicking the ECG changes of STEMI. We report a case of 70-year-old patient with acute peritonitis and pneumoperitoneum secondary to gastric perforation with dynamic ECG changes mimicking anteroseptal STEMI. After the surgery, the ECG dynamically reverted to normal. He was then discharged after 4 days without any remaining symptoms. Misinterpretation of ECG findings may lead to unnecessary aggressive intervention, costly management strategies and delay in appropriate treatment.
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