Introduction:
ST elevation myocardial infarction (STEMI) and gastric perforation are emergencies with progressively higher mortality without emergent intervention. Here we present a case of gastric ulcer perforation presenting as an apparent inferoposterior STEMI.
Case:
A 63-year-old male with hypertension presented with two days of intermittent abdominal pain. While awaiting imaging, the patient developed acute inferoposterior STEMI (figure 1). In route to the cardiac catheterization lab, abdominal CT was emergently reported as gastric ulcer perforation (figure 2). Incorporating multidisciplinary discussions with the cardiac critical care attending, interventionalist, and surgeon, exploratory laparotomy was pursued instead of cardiac catheterization, and the perforation was repaired. Repeat EKG after surgery showed resolution of ST elevations (figure 3) and serial troponins were negative. With no evidence of coronary ischemia, further workup was deferred.
Conclusion:
The unique aspects of this case include how an acute intra-abdominal process can mimic an inferoposterior STEMI and a rapid multidisciplinary approach to decision-making facing two potential concurrent emergencies that was potentially life-saving.
Pneumopericardium Caused by Gastric Ulcer Perforation with Hiatal Hernia