ST-Segment Elevation Mimicking Inferior Wall Myocardial Infarction Caused by Right Tension Pneumothorax

A 71-year-old man was transferred to the hospital’s emergency department with worsening dyspnea. He had been diagnosed previously with severe pulmonary emphysema caused by Aspergillus infection after chemotherapy and transplant therapy for acute myeloid leukemia. ECG revealed ST-segment elevation in leads II, III, and aVF, and ST-segment depression in leads I, aVL, and V2–5 (Figure A). Cardiac enzymes were almost normal. Computed tomography (CT) revealed tension pneumothorax affecting the right lung (Figure D). After the initial examination, his blood pressure abruptly dropped and the heart rate became tachycardic. A chest tube was immediately placed in the right pleural cavity and the ECG showed more marked ST-segment elevation in leads II, III, aVF, and syn-V3R–5R (Figure B). CT revealed a completely re-expanded right lung (Figure E). One hour later, the ST-segment elevation had returned to normal (Figure C). ^{99 m}Tc and ¹²³I-BMIPP dual-isotope SPECT images showed no evidence of ischemic cardiomyopathy.

Figure.

ECG recordings (A) on admission, (B) immediately after insertion of a chest tube showing more marked ST-segment elevation and (C) 1 h after insertion of the chest tube showing a return to normal. CT showing tension pneumothorax affecting the right lung (D) and (E) the completely re-expanded right lung.

Various ECG changes caused by pneumothorax have been reported,¹ but very few have reported inferior ST-segment elevation on ECG in a patient with right tension pneumothorax. In this case, we speculate that the ST changes were caused by compression of the myocardial or right coronary artery, but we were unable to completely elucidate the mechanism. Further accumulation of cases is desirable.

Disclosure

The authors report no financial relationships or conflicts of interest regarding the content of this manuscript.

Funding

Institutional sources only.

IRB Information

This manuscript was approved by the Kyoto Daiichi Red Cross Hospital Ethics Committee (no. 1441).

Supplementary Files

Supplementary Movie. Echocardiogram showed the inferior wall being particularly compressed by a high-echoic structure related to tension pneumothorax.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circj.CJ-22-0135

Reference

• 1.   Krenke R, Nasilowski J, Przybylowski T, Chazan R. Electrocardiographic changes in patients with spontaneous pneumothorax. J Physiol Pharmacol 2008; 59(Suppl 6): 361–373.