Acute Pancreatitis Presenting as Inferior Wall Myocardial Ischaemia: A Case Report

Acute pancreatitis usually presents with epigastric or diffuse abdominal pain. Due to the proximity of the pancreas to the heart, several electrocardiographic abnormalities have been reported. Although ST-segment depression is one of the most commonly reported alterations, localized ST-segment elevation mimicking an acute coronary syndrome (ACS) has only been reported in a few cases. We present a 92-year-old male patient with epigastric pain, whose electrocardiogram (ECG) was concerning for inferior wall ST-elevation myocardial infarction (STEMI) and who was admitted for angioplasty. The final diagnosis after complete blood work was stable coronary artery disease, and the patient was found to present with underlying necrohaemorrhagic pancreatitis. The patient was treated accordingly, with intravenous fluids, vasopressors and antibiotic coverage, but unfortunately died 48 h after admission. This case highlights the rarity and difficulty in discerning a true inferior wall STEMI and a pancreatitis mimicking the ACS and underscores the importance of reporting such cases to raise clinical awareness and guide appropriate management.