PMC8616682_01
(a) Baseline ECG notable for 1st degree AV block and poor R wave progression that was comparable to the patient's prior ECGs. (b) ECG on hospital day 2 showing the interval development of a junctional rhythm along with minor ST segment elevation in leads I, II, and aVL. (c) ECG 36 hours after admission showing persistence of the junctional rhythm along with ST segment elevation in leads I, II, III, aVL, aVF, and V6 along with ST segment depression in leads V1 and V2. This ECG prompted a code STEMI to be activated. (d) ECG after recovery showing a return to normal sinus rhythm with persistence of the 1st degree AV block and a return of the ST segments to their original baseline.
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fig1
Initial ECG at time of admission showed normal sinus rhythm, first-degree AV block, and poor R wave progression (Figure 1). The patient now had a junctional rhythm and nonspecific ST segment elevation in leads I and II (Figure 1). ECG at the time showed ST segment elevation in leads I, II, III, aVL, aVF, and V6 and ST segment depression in V1 and V2 (Figure 1).
Noncontrasted coronal CT images showing a pocket of air in the mediastinum left lateral to the esophagus (red arrow) consistent with esophageal perforation. Green arrow identifies an NG tube within the esophageal lumen.
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After multidisciplinary discussion, a noncontrasted CT scan was performed which revealed a distal esophageal rupture (Figure 2) complicating management of this critically ill patient who was now in shock.
Endoscopic view of the distal esophageal perforation was identified at 31 cm (red arrow).
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After a month, the misleading ECG abnormalities resolved with sepsis management combined with esophageal stenting (Figures 3 and 4).
Endoscopic repair with a stent. The red arrow indicates the perforation.
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After a month, the misleading ECG abnormalities resolved with sepsis management combined with esophageal stenting (Figures 3 and 4).