Gastric volvulus presenting as an acute coronary syndrome with long-lasting electrocardiographic changes

Shi-Lin Fang, Ming Deng, Ya-Nan Peng, Chang Gao, Qiu Zhao, Jing Liu, Xue-Dong Gan
<span title="">2019</span> <i title="China Science Publishing &amp; Media Ltd"> <a target="_blank" rel="noopener" href="https://fatcat.wiki/container/duk4jaqhwvewpmqjdbz6dhldnq" style="color: black;">Journal of Geriatric Cardiology</a> </i> &nbsp;
A sixty-one-year-old male, with a medical history of coronary heart disease and myocardial bridge (not confirmed by cardiac catheterization) in the past three years and a 1-h history of sudden onset nausea, retching, diaphoresis, epigastric discomfort without any chest pain. The electrocardiogram revealed ST elevation myocardial infarction (STEMI) changes ( Figure 1A ). Urgent cardiac catheterization revealed mild myocardial bridge in the middle of the left anterior descending (LAD) (10%
more &raquo; ... c compression) and normal left ventricular function without regional wall motion abnormalities. Three high-sensitivity cardiac troponin I (HSTNT) titers done at 4, 8 and 20 h from the onset of symptoms were HSTNT =10.5 pg/mL, 10.9 pg/mL, 25.4 pg/mL (less than 26.2) with CK-MB = 3 pg/mL, 18 pg/mL, 13 pg/mL (< 25) and the myoglobin levels were = 34.8 pg/mL, 39.6 pg/mL, 44.5 pg/mL (< 140.1), respectively. Full blood count was mild abnormal, and urine analysis, fecal occult blood, serum electrolytes, D-dimer, renal function tests and liver function tests were normal. Serum amylase was 48 U/L (< 90) and serum lipase was 101 mg/dL (< 70); TSH was 1.5970 μIU/mL (0.35-4.94), free T4 1.01 ng/dL (0.70-1.48) and free T3 2.23 ng/dL (1.71-3.71); fasting blood sugar was 5.46 mmol/L and lipid profile was normal. 2D echocardiogram revealed the following sizes and thickness: left atrium, 21 mm; left ventricle, 34 mm; pulmonary artery, 22 mm; interventricular septal thickness, 9 mm; and left ventricular posterior wall thickness, 9 mm.  During the first three days of his hospitalization, the patient complained of progressively worsening up-abdominal pain and was sent for a computed tomographic (CT) scan of *Correspondence to: dhgxd319@163.com (GAN XD); LIU J (liujing_GI@whu.edu.cn) the chest and abdomen. The CT scan revealed gastric volvulus with mass effect on the heart, appearing to be twisted along the mesenteroaxial variety, the left diaphragm elevated, and the stomach body was twisted upwards, with an air-fluid level at CT transverse position ( Figure 1B & 1C) . The patient had subsequently succeeded a conservative approach by endoscopic de-rotation. Within two days, he was discharged home in stable and improved condition. However, his ECG had not returned to normal. Regardless of the ECG 2-h after cardiac catheterization on the day of admission, we performed ECG in different positions in the standing, supine, and right lateral positions, or the ECG of 1-h before and after endoscopy was not changed much. On the second day after gastroscopy, the chest X-ray showed that the level of the left diaphragm was decreased, but still in the elevated position ( Figure 2A ). After 22 months of follow-up, the patient complained of intermittent chest tightness, no nausea, chest and abdominal pain and other discomfort. The electrocardiogram prompted the partial lead ST-T segment elevation change ( Figure 2C ). X-ray angiography of the digestive tract indicated that the gastric volvulus (mesenteroaxial type) changes after the reduction ( Figure 2B ). The CT scan of the chest revealed remain left elevation of the diaphragm, and gastric wall close to the cardiac apex with mass effect on the heart ( Figure 3A & 3B) . For the elevation of the diaphragm and the gastric torsion, we consulted the surgical department later. Because the patient has no difficulty in breathing and chest tightness that is difficult to relieve, the surgical restoration of normal anatomic position of the diaphragm and the stomach are not considered at this time. It is recommended to treat it conservatively and observe it dynamically.
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