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Beyond Cardiology: A Rare Encounter With Small Bowel Obstruction Disguised as Inferior Wall ST-Elevation Myocardial

Akshay Duddu1, Mohammed Rifat Shaik2, Jayashrei Sairam1

  • 1Greater Baltimore Medical Center, Baltimore, MD.

ACG Case Reports Journal
|June 28, 2024
PubMed

Insights

ST segment elevations on an electrocardiogram (EKG) can mimic heart attacks but may signal noncardiac issues like small bowel obstruction (SBO). Prompt diagnosis of SBO resolved EKG changes in this case.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Emergency Medicine

Background:

  • ST segment elevations (STEs) on electrocardiograms (EKGs) typically indicate acute cardiac events.
  • Noncardiac conditions can also manifest as ST segment elevations, complicating diagnosis.

Observation:

  • A 77-year-old woman presented with chest pain, elevated troponins, and inferior lead ST segment elevations on EKG.
  • Initial cardiac workup, including left heart catheterization, revealed no significant coronary artery disease.

Findings:

  • Abdominal computed tomography (CT) scan confirmed small bowel obstruction (SBO).
  • Conservative management of SBO with bowel decompression led to symptom resolution.
  • Follow-up EKG showed complete resolution of ST segment elevations.

Implications:

  • This case highlights the critical importance of considering noncardiac etiologies, such as SBO, in the differential diagnosis of ST segment elevations.
  • Accurate diagnosis and management of noncardiac causes of ST segment elevations are crucial for patient outcomes.
  • Clinicians should maintain a broad differential diagnosis when interpreting EKG findings, especially in the presence of atypical symptoms.

Keywords:
ST elevationSTEMIbowel distentionmyocardial infarctionsmall bowel obstruction

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