Is It Bloating or Is It a Heart Attack?

A patient in the hospital for metastatic Hodgkin lymphoma with significant abdominal distention displayed sudden onset of ST-segment elevations—often an indicator of a heart attack—however the heart attack symptoms improved when the cardiovascular care team pressed on the abdomen during a standard exam, according to a case published in JACC: Case Reports.

"It is important to be aware that, while rare, acute gastrointestinal distention can cause ST-segment changes on an ECG. Clinicians must distinguish these cases from true heart attacks to prevent unnecessary treatment and invasive procedures whenever possible," said Enrique Ostrzega, MD, a cardiologist at the University of Southern California and the senior author of the case report.

Clinicians at the University of Southern California, Los Angeles, admitted a previously healthy 41-year-old male with three weeks of lower extremity swelling, fatigue and shortness of breath. He was taken to the intensive care unit (ICU) and later diagnosed with metastatic Hodgkin lymphoma.

While under sedation on a ventilator in the ICU, the patient's cardiac monitor displayed sudden onset of ST-segment elevation. The ST segment is the interval between ventricular depolarization and repolarization of the heartbeat on an electrocardiogram (ECG). Elevation of this segment can be a sign of a heart attack and is typically known as a "STEMI" (ST-Elevation Myocardial Infarction), which is a serious and high-risk presentation of a heart attack. An ECG in this case was interpreted by a computer algorithm as a heart attack, leading the treating clinicians to call for an emergent cardiology consult.

Read more at American College of Cardiology

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