Inferior ST-Segment Elevation Pattern as a Result of a Small Bowel Obstruction: A Case Report
Archives of Academic Emergency Medicine,
Vol. 13 No. 1 (2025),
6 September 2025
,
Page e77
https://doi.org/10.22037/aaem.v13i1.2843
Abstract
ST segment elevation patterns on Electrocardiogram (ECG) are a crucial finding in the diagnosis and treatment of acute coronary syndrome. An ST segment elevation pattern can be a sign of acute myocardial ischemia requiring immediate intervention. However, ST elevation patterns have been reported to occur due to obstructive intraabdominal pathology, a diagnosis often confirmed by cardiac catheterization. Here we report a 75-year-old female who presented to the emergency department with worsening chest and epigastric abdominal pain. ECG demonstrated ST-segment elevations in inferior leads (II, III, and aVF) with reciprocal changes in the lateral leads (I and aVL). Physical exam was suggestive of a bowel obstruction at the site of a large incarcerated ventral hernia, which was later confirmed by imaging. Due to the lack of typical chest pain symptoms and a strong suspicion of obstructive intraabdominal pathology, activation of the catheterization laboratory was deferred. Decompression of the bowel obstruction was achieved with a nasogastric tube, which resulted in immediate resolution of ST-segment elevations. During her admission, her ventral hernia was repaired, and left heart catheterization was deferred per cardiology recommendations. While an ST-segment elevation due to occlusive myocardial infarction is a diagnosis that cannot be missed and requires an emergent workup, it is important to be aware that it is possible for a small bowel obstruction (SBO) to present with ECG changes consistent with an ST-segment elevation myocardial infarction (STEMI). We also found that ST-segment elevations due to obstructive intraabdominal pathology are more reportedly seen in the literature in the inferior leads than any other contiguous leads, which is a novel pattern not discussed in past literature.
- Small Bowel Obstruction
- stemi
- ventral hernia
- Intestinal atresia
- ST elevation myocardial infarction
- Hernia, ventral
- Myocardial infarction
How to Cite
References
Thygesen K, Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., White, H. D., & Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction Circulation. Circulation. 2018;138(20):e618–e51.
Herath HM TMA, Keragala BS, Udeshika WA, Kulatunga A. Gastric dilatation and intestinal obstruction mimicking acute coronary syndrome with dynamic electrocardiographic changes. BMC Cardiovasc Disord. 2016;16 (1):245.
Hibbs J OQ, Olivari MT, Dickey W, Sharkey SW. Giant J Waves and ST-Segment Elevation Associated With Acute Gastric Distension. Circulation. 2016;133(11):1132-4.
Parikh M AM, Verma I, Osofsky J, Paladugu M. Small Bowel Obstruction Masquerading as Acute ST Elevation Myocardial Infarction. Case Rep Cardiol. 2015;2015:685039.
Upadhyay A CS, Jangda U, Bodar V, Al-chalabi A. Reversible Inferolateral ST-Segment Elevation Associated with Small Bowel Obstruction. Case Rep Med. 2017;2017:5982910.
Birse D. Inferolateral ST-segment elevation associated with a gastric variceal bleed and the use of a Minnesota tube. BMJ Case Rep. 2014;2014:bcr2013202795.
Patel K CN, Shulik O, DePasquale J, Shamoon F. Small Bowel Obstruction Mimicking Acute ST-Elevation Myocardial Infarction. Case Rep Surg. 2015;2015:739147.
Takato T AT, Sugiyama T, Yoshida Y. Marked reversible ST-T abnormalities induced by cardiac compression from a retrosternal gastric tube used to reconstruct the esophagus after tumor resection. A case of a diabetic patient and mini-review of 7 reported patients. Int Heart J. 2006;47(3):475-82.
Baldwin NK IC, Morgan WS, Bowman MH, Chatterjee A. Small Bowel Obstruction Mimicking Acute Inferior ST-Elevation Myocardial Infarction. Am J Med. 2021;134(5):599-602.
Duddu A SM, Sairam J, Jaafar N, Sharma R. Beyond Cardiology: A Rare Encounter With Small Bowel Obstruction Disguised as Inferior Wall ST-Elevation Myocardial Infarction. ACG Case Rep J. 2024;11(7):e01412.
Devarakonda PK RP, Deekonda S, Patipandla S, Singh S, Moreno P. Small Bowel Obstruction imitating a fatal acute ST elevation myocardial infarction. J Clin Med Images Case Rep. 2024;4(3):1676.
- Abstract Viewed: 159 times
- pdf Downloaded: 394 times
Download Statastics
Make a Submission
SJR
COPE
