• Am J Emerg Med · Aug 2023

    Case Reports

    Emphysematous pyelonephritis with ST elevation accompanied by reciprocal changes mimicking acute coronary syndrome.

    • Kiwamu Hatakeyama, Yuji Shono, Takuma Hashimoto, Taiki Sakamoto, Masaaki Nishihara, Takeshi Iyonaga, Soichi Mizuguchi, Takafumi Sakamoto, Jun Maki, and Tomohiko Akahoshi.
    • Emergency and Critical Care Center, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
    • Am J Emerg Med. 2023 Aug 1; 70: 208.e5208.e7208.e5-208.e7.

    AbstractPatients with infectious diseases including sepsis can develop ST segment changes on an electrocardiogram (ECG) in the absence of coronary artery disease. However, ST elevation with "reciprocal ST segment depression (RSTD)", which is recognized as a specific finding for ST-elevated myocardial infarction, is rare in such patients. Although a small number of cases have reported ST-segment elevation in gastritis, cholecystitis, and sepsis, regardless of coronary artery disease, none presented with reciprocal changes. Here, we describe a rare case of a patient with emphysematous pyelonephritis complicating septic shock who developed ST elevation accompanied by reciprocal changes with no coronary occlusion. Emergency physicians should consider the possibility of acute coronary syndrome mimicking, and choose non-invasive diagnostic procedures when investigating the causes of ECG abnormalities associated with critically ill patients.Copyright © 2023 Elsevier Inc. All rights reserved.

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