Ileus causing STEMI electrocardiographic findings.

A man in his 70s presented with ST-segment elevation in inferolateral leads on ECG associated with nausea, vomiting, and epigastric discomfort.

• The patient presented with nausea, vomiting, and epigastric discomfort
• ECG showed ST-segment elevation in the inferolateral leads
• The presentation mimicked ST-elevation myocardial infarction (STEMI)

Coronary angiography revealed no coronary artery stenoses, ruling out obstructive coronary artery disease as the cause of ST-segment elevation.

• No coronary artery stenoses were found on coronary evaluation
• This finding excluded a primary ischemic etiology for the ECG changes

CT scan identified gastric and jejunal loop dilation as the underlying cause of the ST-segment elevation.

• CT scan displayed gastric and jejunal loop dilation
• The imaging finding indicated ileus as the precipitating condition
• Mild myocardial damage was also noted in association with the gastric dilation

ST-segment elevation resolved after gastric decompression, confirming the causal relationship between gastric dilation and ECG changes.

• The ECG returned to normal after gastric decompression
• Resolution of ECG abnormalities following decompression supports a mechanistic link between gastric dilation and the cardiac findings

The authors propose that cardiac external compression and myocardial injury from gastric dilation is the likely mechanism for the ST-segment elevation.

• Authors state findings are 'likely related to cardiac external compression and injury on a limited myocardial region'
• Several mechanisms might be implicated, though external compression was considered most likely
• The case demonstrates that gastric compression on the heart is a non-cardiac cause of ST-segment elevation and mild myocardial damage

The authors recommend investigating gastric dilation as a non-cardiac cause of ST-segment elevation after ruling out myocardial infarction in suggestive clinical presentations.

• Physicians must investigate gastric dilation after ruling out myocardial infarction in case of a suggestive clinical presentation
• The case underscores gastric compression as a recognized non-cardiac etiology of ST-segment elevation
• Clinical presentation features such as nausea, vomiting, and epigastric discomfort should prompt consideration of this diagnosis