Credits: Norton Healthcare

How to Tell if it’s a Heart Attack or Just Bloating?

A new case report published in the Journal JACC shows that severe bloating can squeeze the heart and trigger heart monitor readings that can be mistaken for a heart attack. This is a case of a 41-year-old man who was seen by doctors at the University of Southern California in Los Angeles after 21 days of fatigue, shortness of breath, and lower extremity swelling.

Doctors admitted him to the intensive care unit (ICU). Later, the patient was diagnosed with metastatic Hodgkin lymphoma.

Read the report in detail here.

A cardiologist at the University of Southern California and the senior author of the case report, Enrique Ostrzega tells that it is essential to know that ST-segment changes on an ECG are caused by acute gastrointestinal distention. Clinicians must recognize these cases from true heart attacks to avoid unnecessary treatment and intrusive methods.

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While under sedation on a ventilator in the Intensive Care Unit (ICU), the cardiac monitor of the patient showed a sudden onset of ST-segment elevation. As on the electrocardiogram (ECG), the ST segment is the interval between repolarization and ventricular depolarization of the heartbeat.

This sudden elevation of ST-segment can be an indication of cardiovascular failure and is normally known as a “STEMI” (ST-Elevation Myocardial Infarction), which is a serious and dangerous introduction of a heart attack. In this case, ECG was interpreted as a heart attack by the computer algorithm.

An associate professor of medicine at the University of Nebraska Medical Center, Alex Hewlett recommends seeking medical care if bloating is persistent and does not differ with changing dietary patterns or solid discharges.

Both heart attack and liver disease are the later symptoms of bloating. Once a person gets bloating it means the disease will affect his heart or liver in advance. Congestive heart failure can also cause bloating, not only in the abdomen but with swelling in the legs too.

When doctors placed pressure on the upper abdomen of the patient, the cardiac monitor stopped showing ST-segment elevations. These dynamic changes were affirmed with the help of ECG.

After a nasogastric tube was put for gastric decompression an ECG confirmed the halt of ST-segment elevations with no further recorded ST-fragment abnormalities and the patient had no signs of a heart attack.

 The consulting team of cardiology speculated the reason might be related to the patient’s stomach extension and a stomach X-beam was performed, which uncovered significant gastric distension.

 As per the report, when an atypical occasion of ST-segment elevation was presented on ECG, thorough examination and history are essential as various other issues can mimic a STEMI pattern on ECG.

Community-acquired pneumonia, intracranial bleeding, and pancreatitis are non-heart related causes of ST-segment elevation.

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In previously reported cases of gastrointestinal distension causing a STEMI pattern on ECG, coronary angiography confirmed no proof of obstructive coronary artery disease, and in all reported cases it improved with the board and goals of the hidden gastrointestinal issue.

The report authors tell that it is the first case where a direct physical maneuver caused a reversal of ST-segment elevations. The authors believe the gastric expansion prompted a direct compressive impact on the heart and the use of mild pressure on the stomach assuaged or shifted the impact.

The MD, Ph.D., FACC, and editor-in-chief of JACC, Julia Grapsa tells that setting up the right differential diagnosis and careful clinical assessment is the foundation of the treatment of each patient. It’s her perception that the authors treated the patient without requiring interventional methods.