BACKGROUND Chest pain associated with transient electrocardiogram changes mimicking an acute myocardial infarction have been described in acute pancreatitis. These ischemic electrocardiogram changes can present a diagnostic dilemma, especially when patients present with concurrent angina pectoris and epigastric pain warranting noninvasive or invasive imaging studies. CASE PRESENTATION A 45-year-old African-American man with a history of alcohol use disorder presented to the emergency department of our institution with 36 hours of concurrent epigastric pain and left-sided chest pain radiating to his left arm and associated with nausea and dyspnea. On physical examination, he was afebrile; his blood pressure was elevated; and he had epigastric tenderness. His laboratory test results were significant for hypokalemia, normal troponin, and elevated serum lipase and amylase levels. Serial electrocardiograms for persistent chest pain showed ST-segment elevations with dynamic T-wave changes in the right precordial electrocardiogram leads, consistent with Wellens syndrome. He was immediately taken to the cardiac catheterization laboratory, where selective coronary angiography showed normal coronary arteries with an anomalous origin of the right coronary artery from the opposite sinus. Given his elevated lipase and amylase levels, the patient was treated for acute alcohol-induced pancreatitis with intravenous fluids and pain control. His chest pain and ischemic electrocardiogram changes resolved within 24 hours of admission, and coronary computed tomography angiography showed an interarterial course of the right coronary artery without high-risk features. CONCLUSIONS Clinicians may consider deferring immediate cardiac catheterization and attribute electrocardiogram changes to acute pancreatitis in patients presenting with angina pectoris and acute pancreatitis if confirmed by normal cardiac enzymes and elevated levels of lipase and amylase. However, when clinical signs and electrocardiogram findings are highly suggestive of myocardial ischemia/injury, immediate noninvasive coronary computed tomography angiography may be the best approach to make an early diagnosis.

中文翻译：

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假性Wellens综合征，急性胰腺炎和冠状动脉异常：病例报告。

背景技术在急性胰腺炎中已经描述了与模仿急性心肌梗塞的与瞬时心电图改变相关的胸痛。这些缺血性心电图的变化可能会带来诊断上的两难境地，特别是当同时存在心绞痛和上腹痛的患者需要进行非侵入性或侵入性成像研究时。病例介绍一名有酗酒史的45岁非洲裔美国人，在向我们机构急诊科就诊的同时，有36小时并发上腹部疼痛和左侧胸腔放射到他的左臂，并伴有恶心和恶心。呼吸困难。经身体检查，他很发热。他的血压升高了；他有上腹部的压痛。他的实验室检查结果对血钾过低，肌钙蛋白正常，以及血清脂肪酶和淀粉酶水平升高。持续性胸痛的系列心电图显示右心前区心电图导联中ST段抬高且动态T波改变，与Wellens综合征一致。他立即被带到心脏导管实验室，在该实验室中，选择性冠状动脉造影显示正常冠状动脉，其右冠状动脉起源于对侧窦。鉴于其脂肪酶和淀粉酶水平升高，该患者接受了静脉输液和止痛治疗，以治疗急性酒精引起的胰腺炎。他的胸痛和局部缺血性心电图变化在入院后24小时内得到解决，冠状动脉计算机断层扫描血管造影显示右冠状动脉的动脉间进程无高危特征。结论如果心力衰竭和急性胰腺炎表现为正常的心脏酶和脂肪酶和淀粉酶水平升高，临床医生可考虑推迟立即进行心脏导管插入术，并将心电图改变归因于患有急性心绞痛和急性胰腺炎的急性胰腺炎。但是，当临床体征和心电图检查结果高度提示心肌缺血/损伤时，立即进行非侵入性冠状动脉计算机断层扫描血管造影可能是进行早期诊断的最佳方法。