SHM Converge Scientific Abstract ePoster Gallery-Pneumothorax Causing St-Segment Elevation Concerning for Acute Myocardial Infarction

Pdf Summary

This case describes a 69-year-old woman with sudden right-sided chest tightness and dyspnea, initially concerning for acute myocardial infarction because her ECG showed ST-segment elevation in leads II, III, and aVF. Given her history of coronary artery disease and prior PCI, a STEMI protocol was activated and transfer for emergent catheterization was arranged.<br /><br />However, further evaluation revealed an alternate cause: chest x-ray demonstrated a large right-sided pneumothorax with mediastinal shift, raising concern for impending tension pneumothorax. She had markedly decreased breath sounds on the right, and her troponin I was normal. An emergent right chest tube was placed, which resolved the pneumothorax on repeat imaging.<br /><br />She was then transferred and underwent coronary angiography, which showed patent stents, no culprit lesion, and only minor coronary artery disease. She improved and was discharged five days later after chest tube removal.<br /><br />The discussion emphasizes that pneumothorax, especially right-sided pneumothorax, can produce ECG abnormalities that mimic myocardial ischemia, including ST-segment changes, axis shifts, bundle branch block patterns, and QRS amplitude changes. Proposed mechanisms include cardiac rotation/displacement, ventricular dilation, and electrical insulation caused by air between the heart and chest wall. ECG changes often resolve after decompression.<br /><br />The key clinical lesson is that chest pain should be evaluated with both ECG and baseline chest imaging, because pneumothorax can imitate STEMI and delay appropriate treatment if not recognized.

Asset Subtitle

Mithun R. Suresh

Meta Tag

Author List Mithun R. Suresh

Category Clinical Vignettes

Concept Pneumothorax

Concept Tension Pneumothorax

Concept Needle Decompression

Concept Chest Tube

Concept Electrocardiogram Abnormality

Distinguished Non-Finalist

Presenter Organization CentraCare

Presenting Author Mithun R. Suresh

Track Adult

Keywords

pneumothorax

ST-segment elevation

myocardial infarction mimic

chest pain

dyspnea

right-sided pneumothorax

ECG changes

tension pneumothorax

coronary angiography

chest tube

Pneumothorax

Tension Pneumothorax

Needle Decompression

Chest Tube

Electrocardiogram Abnormality