Introduction: Patients presenting with typical angina accompanied by electrocardiographic changes suggestive of myocardial ischemia are most commonly diagnosed with coronary heart disease. However, there are particular situations in which a non-cardiac pathology is the basis of pain symptoms and ECG changes. We present the case of a patient with a clinical and electrocardiographic picture suggestive of acute coronary syndrome, determined by an esophageal obstruction with a food bowl (in a newly diagnosed achalasia).
Methods: We are presenting a case of a 52 years old male admitted to hospital for constrictive retrosternal pain, irradiated to the mandible, accompanied by dyspnea, nausea and emesis, symptoms that have begun for about 10 hours and progressively worsened. The ECG shows sinus tachycardia, with negative T wa-ves in v1-v6 and raises the suspicion of an acute co-ronary syndrome without ST-segment elevation. Labo-ratory work-up revealed mild hepatocytolysis, but wi-thout enzymatic dynamics compatible with myocardial necrosis and D-dimers >5 ug / mL. Since echocardio-graphy reveals slightly dilated right cavities, with pre-served left ventricular ejection fraction, without kinetic disorders, we decided to perform computed tomogra-phy of the chest. The investigation excludes pulmo-nary thrombembolism but describes dilated esophagus throughout the thoracic segment, with liquid and air content and apparent sudden narrowing of the cardia. At the resumption of the anamnesis, the patient states dysphagia for liquids and solids from the previous evening and feeling of a „lump in the throat“. An upper digestive endoscopy was performed and revealed in the middle third of the esophagus a partially digested food bowl – the investigation being interrupted due to the patient’s lack of cooperation. Post-procedural the chest pain and dysphagia were significantly improved and repolarization disorders resumed. Repeated endoscopy two hours later revealed lesions of supracardial esopha-gitis, without food bowl in the lumen and stomach with erythematous pangastritis. Subsequent investigations confirmed the diagnosis of achalasia.
Results: The differential diagnosis in patients with typical angina is often facilitated by the presence or absence of ECG changes suggestive of myocardial ischemia. In the described case, the clinical-electrocardiographic picture was determined by the presence of a transient esophageal obstruction in patient with newly diagno-sed achalasia.
Conclusions: Although electrical repolarization disor-ders have been described in the literature in patients with gastroenterological disorders, we found only two cases similar to the one presented (anterior thoracic pain and ECG changes in patients with esophageal obstruction caused by food bowl). Questions remain about the mechanisms involved in the onset of repola-rization disorders in these patients, whether the chan-ges are caused by concomitant ischemic myocardial distress or whether they occur only in the context of exacerbation of the digestive disorder.