Pneumopyopericardium mimicking an inferior ST elevation myocardial infarction with regional electrocardiogram changes: a case report.
BACKGROUND
Pneumopyopericardium is a rare disease with poor prognosis. The usual presentation is with fever, shortness of breath and haemodynamic compromise. The Electrocardiogram changes associated with this disease entity would be similar to pericarditis such as concave shaped ST elevations in all leads with PR sagging. Pneumopyopericardium mimicking an acute ST Elevation Myocardial Infarction, with regional Electrocardiogram changes has hitherto not been described in world literature.


METHODS
We describe the case of a 48 year old native Sri Lankan man, presenting with chest pain and Electrocardiogram changes compatible with an Acute ST Elevation Myocardial Infarction, subsequently found to have Pneumopyopericardium secondary to an oesophageal tear. Retrospective history revealed repetitive vomiting due to heavy alcohol consumption, prior to presentation. It unfortunately led to a fatal outcome.


CONCLUSIONS
Pneumopyopericardium may mimic an acute ST elevation myocardial infarction with associated regional Electrocardiogram changes. A high degree of suspicion should be maintained and an adequate history should always be obtained prior to any intervention in all ST Elevation Myocardial Infarction patients.
Institute of Cardiology, National Hospital of Sri Lanka, Regent Street, Colombo 7, Sri Lanka. chamara.ratnayake@gmail.com.
Eranda Chamara
EC
Ratnayake
Institute of Cardiology, National Hospital of Sri Lanka, Regent Street, Colombo 7, Sri Lanka. sandamali_premaratne@yahoo.com.
Sandamali
S
Premaratne
Institute of Cardiology, National Hospital of Sri Lanka, Regent Street, Colombo 7, Sri Lanka. niroshan_loku@yahoo.com.
Niroshan
N
Lokunarangoda
Institute of Cardiology, National Hospital of Sri Lanka, Regent Street, Colombo 7, Sri Lanka. sandunigf@yahoo.com.
Sanduni
S
Fernando
Institute of Cardiology, National Hospital of Sri Lanka, Regent Street, Colombo 7, Sri Lanka. nikifern2007@yahoo.com.
Nilanthi
N
Fernando
Institute of Cardiology, National Hospital of Sri Lanka, Regent Street, Colombo 7, Sri Lanka. chanrikep@yahoo.com.
Chandrike
C
Ponnamperuma
Institute of Cardiology, National Hospital of Sri Lanka, Regent Street, Colombo 7, Sri Lanka. santharaj@yahoo.com.
W Samuel
WS
Santharaj
D003937:Diagnosis, Differential; D003974:Diatrizoate Meglumine / Q000494:pharmacology; D004562:Electrocardiography; D004947:Esophagus / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011026:Pneumopericardium / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D012421:Rupture; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D003974:Diatrizoate Meglumine