Pseudo–Myocardial Infarction

Abstract

A 41-year-old man was admitted to the hospital because of severe lower sternal pain with diaphoresis for 1 hour.He had no history of peptic ulcer disease and denied smoking, alcohol abuse, and use of illicit drugs.An ECG (Figure 1) revealed ST-segment elevation of 2 mm and peaked upright T waves in leads V 1 through V 3 , with reciprocal changes in lead II and inverted T waves in V 4 through V 6 .Particular noteworthy were the bizarre T waves observed in the limb leads.Cardiac enzymes, liver function tests, and serum electrolytes, amylase, and lipase were within normal limits.A diagnosis of acute myocardial infarction was suspected.Thrombolytic therapy was considered but was rejected by the patient.Intravenous nitroglycerin, heparin, and ␤-blocker were administered but did not ameliorate his symptoms.An echocardiogram showed no wall motion abnormalities.Serial cardiac enzymes were normal.A contrast-enhanced CT scan (Figure 2) and MRI (Figure 3) of the abdomen 1 day after