title: [Acute chest pain and new ECG changes in pacemaker patients : A clinical challenge].
abstract: We report the case of a 82-year-old woman who was admitted to our institution with acute chest pain, nausea, and vomiting. Because of atrial fibrillation with intermittent bradycardia, a single-chamber pacemaker was implanted 4 years ago. The initial 12-lead ECG showed atrial fibrillation with a heart rate of 70 bpm, narrow QRS, and T‑wave inversions in the inferolateral leads. Coronary artery disease was excluded by immediate cardiac catheterization. A subsequent ECG three hours later showed a ventricular paced rhythm. During the subsequent clinical course, cardiac injury markers remained normal. However, serum amylase and lipase levels were 5 times above the normal range. According to these clinical findings, acute pancreatitis was the most likely diagnosis. Abdominal ultrasound excluded pancreatic necrosis and gallstones. Initial treatment consists of fasting, pain control, and intravenous fluids with resolution of symptoms after a few days. The patient could be discharged 7 days later. In conclusion, the observed ECG findings in combination with chest pain are suggestive for myocardial ischemia mandating immediate cardiac catheterization. However, acute pancreatitis might present with the aforementioned ECG changes and symptoms. The case was further complicated by a distinct electrocardiographic memory effect due to intermittent ventricular pacing.
authors.affiliation: Klinik für Innere Medizin I, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hoyme
authors.affiliation: Klinik für Innere Medizin I, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland.
authors.forename: Ralf
authors.initials: R
authors.lastname: Surber
authors.affiliation: Klinik für Innere Medizin I, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland.
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
authors.affiliation: Klinik für Innere Medizin I, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland. Dirk.Prochnau1@gmail.com.|Klinik für Innere Medizin ll, Katholisches Krankenhaus "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Deutschland. Dirk.Prochnau1@gmail.com.
authors.forename: Dirk
authors.initials: D
authors.lastname: Prochnau
mesh_terms: D059787:Acute Pain / Q000175:diagnosis / Q000209:etiology; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology*; D003324:Coronary Artery Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D010138:Pacemaker, Artificial; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis*
keywords: Acute chest pain; Cardiac memory effect; ECG; Intermittent cardiac pacing; Pancreatitis