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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Unexpected Findings in Diffuse ST-Segment Depression and aVR ST-Segment Elevation.

Mohamed El Mallouli1, Amina El Bakkali2, Usama Azziz1

  • 1Cardiology Department, CHU Brugmann, 1020 Brussels, Belgium.

Diagnostics (Basel, Switzerland)
|May 13, 2026
PubMed
Summary
This summary is machine-generated.

Electrocardiogram (ECG) changes mimicking heart attack are rare in gastric perforation. This case highlights diffuse ST-segment depression and aVR ST-segment elevation as potential indicators of this critical gastrointestinal emergency.

Keywords:
diffuse ST-segment depressionelectrocardiogramgastric perforation

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Published on: July 20, 2022

Area of Science:

  • Cardiology
  • Gastroenterology
  • Emergency Medicine

Background:

  • Electrocardiographic (ECG) changes mimicking myocardial ischemia are uncommon in gastrointestinal emergencies.
  • Gastric perforation is rarely associated with ECG abnormalities, with ST-segment elevation being previously reported, but not ST-segment depression mimicking non-ST-segment elevation myocardial infarction (NSTEMI).

Purpose of the Study:

  • To report the first case of gastric perforation presenting with diffuse ST-segment depression and ST-segment elevation in lead aVR.
  • To emphasize the importance of considering gastric perforation in the differential diagnosis of patients with these specific ECG findings.

Main Methods:

  • Case report of a 60-year-old woman with sudden epigastric pain radiating to the chest.
  • ECG analysis showing diffuse ST-segment depression and ST-segment elevation in aVR.
  • Laboratory tests (troponin, inflammatory markers), coronary angiography, left ventriculography, and abdominal computed tomography (CT) were performed.
  • Laparoscopic gastric repair and abdominal lavage.

Main Results:

  • The patient presented with hemodynamic stability but significant ECG abnormalities.
  • Coronary angiography and left ventriculography ruled out significant coronary artery disease and showed preserved left ventricular function.
  • Abdominal CT confirmed gastric perforation with pneumoperitoneum and gastric wall thickening.
  • Postoperative ECG showed complete resolution of ST-segment abnormalities.

Conclusions:

  • This case represents the first documented instance of gastric perforation presenting with diffuse ST-segment depression and aVR ST-segment elevation.
  • Clinicians should be aware of this rare ECG presentation to facilitate timely diagnosis and management of gastric perforation, avoiding unnecessary cardiac interventions.
  • Recognizing this association broadens the diagnostic spectrum for gastrointestinal emergencies presenting with atypical cardiac signs.