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Published on: June 11, 2019
Occult Penetrating Trauma: A STEMI Mimic Hiding in Plain Sight
Xiaoling He1, Yajie Li1, Weigang Luo1
1Department of Cardiology, Port District Branch of Baoji Central Hospital, Baoji, Shaanxi, China.
Background:
We report a case of acute pericarditis caused by an occult penetrating foreign body manifesting as an ST-segment elevation myocardial infarction mimic.
Case Summary:
The patient initially presented with chest pain, increased cardiac troponin I, and ST-segment elevation. Following emergency intravenous thrombolysis and urgent coronary angiography, an alternative etiology was suspected. Subsequent verification of the medical history and imaging examinations ultimately identified the culprit: a nail. The patient received prompt treatment, and the pericardial foreign body was successfully extracted.
Discussion:
Acute pericarditis and acute myocardial infarction are common causes of acute chest pain. Diagnostic confusion and treatment delays may arise due to overlapping symptoms, elevation of cardiac biomarkers, ST-segment elevation, cognitive bias, and incomplete history taking.
Take-Home Messages:
This case highlights the value of bedside echocardiography combined with chest radiography. In patients with suspected ST-segment elevation myocardial infarction, it is crucial to differentiate acute coronary occlusion from other causes, especially foreign body-induced pericarditis.
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