SHM Converge Scientific Abstract ePoster Gallery-An Unusual Case of Pancreatitis

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A 67-year-old woman with prior NSTEMI, coronary artery disease with an RCA stent, hypertension, and hyperlipidemia presented with several days of worsening epigastric and chest pain radiating to her back, along with chills and nausea. Exam showed epigastric tenderness without peritoneal signs. Labs revealed an elevated lipase of 662 with otherwise unremarkable liver and renal tests and normal serial high-sensitivity troponins. Her ECG showed new inferior ST-segment elevations with reciprocal changes, raising concern for acute coronary syndrome.<br /><br />Because of the ECG findings and her cardiac history, she underwent emergent left heart catheterization, which showed non-obstructive coronary arteries and a patent RCA stent. A transthoracic echocardiogram found a small pericardial effusion. Abdominal CT with contrast was consistent with acute pancreatitis and showed no necrosis, collection, or thrombus. She was treated with intravenous fluids and pain control, improved quickly, and was discharged on hospital day two.<br /><br />This case highlights that acute pancreatitis can mimic acute coronary syndrome, including causing ST-segment elevations on ECG. While ST elevations often prompt urgent evaluation for myocardial infarction, clinicians must remember that non-cardiac conditions can produce similar ECG changes. Recognizing the full clinical picture and using appropriate diagnostic testing is essential to avoid unnecessary invasive procedures and to ensure correct treatment of the underlying illness.

Asset Subtitle

Robert M. Krahmer

Meta Tag

Author List Nikesh Rohit Kapadia, Robert M. Krahmer

Category Clinical Vignettes

Concept Acute Pancreatitis

Concept ST Elevation

Concept Acute Coronary Syndrome

Concept Lipase

Concept Epigastric Pain

Distinguished Non-Finalist

Presenter Organization University of South Florida

Presenting Author Robert M. Krahmer

Track Adult

Keywords

acute pancreatitis

ST-segment elevation

acute coronary syndrome

epigastric pain

coronary artery disease

NSTEMI

left heart catheterization

pericardial effusion

elevated lipase

non-obstructive coronary arteries

Acute Pancreatitis

ST Elevation

Acute Coronary Syndrome

Lipase

Epigastric Pain