CA4 Esophageal impaction presenting as an ST segment elevation myocardial infarction. (Cardiology).

CA4 ESOPHAGEAL IMPACTION PRESENTING AS AN ST SEGMENT ELEVATION MYOCARDIAL INFARCTION. W. Clarkson, DO, W. Dixon, MD, and M. Peele, MD. Brooke Army Medical Center, Ft. Sam Houston, Tex.

Electrocardiograms (ECG) are frequently obtained as part of triage in the emergency department (ED) and often show nonspecific findings. Gastrointestinal disorders have been described to cause an ischemic pattern on ECG. ST elevation, however, is usually indicative of myocardial injury. We present a case of esophageal impaction presenting as an acute anteroseptal myocardial infarction. A 69-year-old healthy man reported to the ED with a chief complaint of a nectarine pit caught in his throat. Otolaryngology was consulted, and he was taken to the operating room for surgical removal. While being prepped for surgery, he vomited, causing the pit to become dislodged. His symptoms then resolved, and he was discharged to home. Four hours later, the patient returned to the ED with complaints of nausea, lightheadedness, diaphoresis, and the urge to defecate. Initial heart rate was 94/min, and blood pressure was 134/77 mm Hg. ECG showed 3 to 4 mm of ST elevation in leads V1 and V2, concerning for acute anteroseptal myo cardial infarction. The patient was taken to cardiac catheterization where he was found to have nonobstructive coronary artery disease and normal flow. Transthoracic echocardiogram revealed no wall motion abnormality, and the ECG had begun to normalize by the next day. Biologic markers of myocardial injury were negative. Workup for esophageal rupture was negative. We propose that the ECG abnormality seen in this patient was due to the acute esophageal process. There has been one reported case in the literature describing esophageal food impaction causing ECG changes consistent with ischemia. However, that case did not have angiographic confirmation. This case is unique in that there was documentation of normal coronary flow, normal ventricular wall motion, and negative cardiac enzymes.