Is it a heart attack or just bloating?

  • Sophisticated medical equipment can sometimes give false readings
  • A man who was sedated and on a ventilator in the ICU showed signs of a heart attack when he was merely bloated
  • Non-heart-related possible causes of such false readings include pancreatitis, pneumonia and intracranial bleeding

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Severe bloating can put pressure on the heart and trigger heart monitor readings that can be mistaken for a heart attack, a new case report shows.

It involved a previously healthy 41-year-old man who was seen by doctors at the University of Southern California in Los Angeles, after three weeks of lower extremity swelling, fatigue and shortness of breath.

He was taken to the intensive care unit and later diagnosed with metastatic Hodgkin lymphoma.

While under sedation on a ventilator in the ICU, the man's heart monitor suddenly showed the onset of ST-segment elevations – often an indicator of a heart attack.

Preventing unnecessary treatment

But when pressure was placed on the man's upper abdomen to assess the severe bloating, the heart monitor suddenly stopped showing ST-segment elevations, according to the report in the 15 April issue of the journal JACC: Case Reports.

After a nasogastric tube was inserted to relieve the man's bloating, an electrocardiogram (ECG) confirmed the halt of ST-segment elevations, and the man did not have any further signs of heart trouble.

"It is important to be aware that, while rare, acute gastrointestinal distention can cause ST-segment changes on an ECG. Clinicians must distinguish these cases from true heart attacks to prevent unnecessary treatment and invasive procedures whenever possible," senior author and cardiologist Dr Enrique Ostrzega said in a journal news release.

Some non-heart-related causes of ST-segment elevation include pancreatitis, community-acquired pneumonia and intracranial bleeding.

"Careful clinical examination and setting up the correct differential diagnosis is the cornerstone of the treatment of every patient. Here – starting from an important observation – [the authors] treated the patient without needing interventional procedures," journal editor-in-chief Dr Julia Grapsa said in the release.

Image credit: iStock

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