SYNOPSIS: A variety of non-cardiac conditions have been reported to present with ischemic heart disease clinically and electrocardiographically like cholecystitis which leads to nonspecific T-wave inversions or ST-segment depressions, rarely it leads to ST-segment elevation.
CLINICAL PRESENTATION: We report a case of a 58-year-old,male, hypertensive, diabetic, and with hyperthyroidism on medication. Patient presents with two weeks history of epigastric pain associated with nausea and vomiting.Symptoms spontaneously resolved until one day prior to admission patient developed persistent abdominal pain.Patient was seen at a local hospital wherein work-up was done which showed leukocytosis on CBC, hydrops of gallbladder on ultrasound. Further work-up were anteroseptal wall ST elevation on ECG with negative cardiac enzymes. Patient was advised transfer to our institution.
PHYSICAL FINDINGS: Pertinent Physical exam includes tachycardia, epigastric tenderness and positive Murphy's sign. During the course, patient developed fever and jaundice.
LABORATORY WORK-UP: Repeat CBC still showed leukocytosis with neutrophilia. Repeat electrocardiogram showed anteroseptal wall ST elevation with negative Troponin.Echocardiogram showed adequate ejection fraction and adequate wall motion contractility.Thyroid function test showed increased FT4 and decreased TSH.
TREATMENT: Patient was initially started with acute coronary syndrome regimen. Antibiotics were initiated and anti-thyroid and anti-diabetes drugs were adjusted accordingly.There was noted progressive abdominal pain; hence, patient was referred to surgery. Patient was cardio-pulmonary and endocrinologically prepared and cleared for the procedure. Patient tolerated the procedure.
OUTCOME: Patient was discharged improved with noted improvement of the electrocardiogram.