Esophageal Rupture Presenting with ST Segment Elevation and Junctional Rhythm Mimicking Acute Myocardial Infarction.
Wytch RiggerRaymond MaiP Tim MadduxStuart CavalieriJoe CalkinsPublished in: Case reports in critical care (2021)
Esophageal rupture is a rare but potentially fatal cause of chest pain. The presentation is variable and can mimic other conditions such as aortic dissection, pulmonary embolism, and myocardial infarction (MI). A 71-year-old male with a history of coronary artery disease presented to the ED with complaints of acute chest pain and respiratory distress. Over the next 48 hours, the patient developed dynamic ST segment changes on surface electrocardiogram mimicking an inferolateral ST segment elevation MI accompanied by a junctional rhythm. Curiously, his cardiac enzymes remained negative during this time, but his clinical status continued to deteriorate. A subsequent CT scan demonstrated a lower esophageal rupture, and the patient underwent successful endoscopic stenting. While rare, prompt recognition of esophageal rupture is imperative to improving morbidity and mortality. While esophageal rupture has been noted to cause ST segment elevation before, this appears to be the first case associated with a junctional rhythm.
Keyphrases
- pulmonary embolism
- aortic dissection
- case report
- acute myocardial infarction
- coronary artery disease
- atrial fibrillation
- left ventricular
- heart rate
- computed tomography
- emergency department
- heart failure
- liver failure
- type diabetes
- magnetic resonance imaging
- blood pressure
- cardiovascular disease
- cardiovascular events
- coronary artery bypass grafting
- contrast enhanced
- aortic stenosis
- respiratory tract