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Transient ST elevation associated with tension pneumothorax.

R D Slay, L E Slay, J G Luehrs

    JACEP
    |January 1, 1979
    PubMed
    Summary
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    Tension pneumothorax can cause temporary heart injury, mimicking a heart attack. Prompt treatment resolved these electrocardiogram changes without lasting heart damage.

    Area of Science:

    • Cardiology
    • Pulmonology
    • Emergency Medicine

    Background:

    • Tension pneumothorax is a life-threatening condition characterized by air accumulation in the pleural space, leading to cardiorespiratory compromise.
    • Electrocardiogram (ECG) abnormalities can occur in various critical illnesses, but their specific association with tension pneumothorax is not well-documented.

    Observation:

    • A 52-year-old male presented with spontaneous right tension pneumothorax.
    • The patient exhibited transient bradycardia, hypotension, and precordial ST elevation on ECG, suggestive of acute myocardial injury.
    • Immediate chest tube placement resulted in near-normalization of the ECG.

    Findings:

    • Cardiac enzymes and isoenzymes showed no evidence of myocardial infarction.
    • This case represents the first reported association between tension pneumothorax and ECG changes mimicking acute myocardial injury.

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  • The observed ECG changes are hypothesized to be secondary to the hypotensive state induced by tension pneumothorax, causing reduced coronary artery blood flow and transient myocardial ischemia.

    • Implications:

    • This association highlights the importance of considering tension pneumothorax in the differential diagnosis of acute cardiac symptoms, especially in the presence of hypotension and respiratory distress.
    • Prompt recognition and management of tension pneumothorax are crucial for reversing potentially life-threatening cardiovascular effects.
    • Further research may elucidate the precise mechanisms linking tension pneumothorax to myocardial ischemia and guide diagnostic and therapeutic strategies.