Chest
Volume 81, Issue 4, April 1982, Pages 444-448
Journal home page for Chest

Clinical Investigations
Acute and Transient ST Segment Elevation During Bacterial Shock in Seven Patients Without Apparent Heart Disease

https://doi.org/10.1378/chest.81.4.444Get rights and content

Acute elevation of the ST segment in several ECG leads was observed in seven patients with bacterial shock daring the coarse of therapy. Six patients had bacterial pneumonia, one had acute cholecystitis, and none had a previous history of heart disease. At the onset of the ST elevation, all patients were receiving dopamine infusion, which in four of them was inadvertently increased shortly before the ECG changes. The ST elevation was not associated with chest pain, pericardial friction rub, or acute changes in the heart rate, or arterial Mood pressure. In four patients the maximum ST elevation was ≥ 5 mm. In each instance the ST segment returned to the isoelectric line within 24 hours, and subsequent development of Q waves or changes in the QRS was not observed. Although the existence of an acute pericarditis or an acute myocarditis as possible causes of the ST elevation cannot be fully ruled out, the sudden onset, prominent magnitude, and brief duration of the ST elevation are perhaps more indicative of an acute ischemic event, possibly related to a transient coronary vasoconstriction induced by the dopamine infusion.

Section snippets

CASE 1

This was a 57-year-old man, a heavy smoker, who had no relevant past medical history. Three days prior to admission, he had fever, right pleuritic chest pain, asthenia, and progressive dyspnea. On admission he was hypotensive and had clinical signs of shock and of respiratory insufficiency. Chest x-ray examination demonstrated a right upper lobe pneumonia, and a normal cardiac size. The ECG was within normal limits (Fig 1). Treatment was begun with penicillin G, intravenous (IV) fluids, and

DISCUSSION

We report the observations of transient ST elevation during treatment of bacterial shock in seven patients who had no history of heart disease. In four patients the maximum ST elevation was equal to or greater than 5 mm. In all patients, the ST segment returned to the isoelectric line within 24 hours, and in five it decreased to 50 percent of the maximal elevation within the first six hours.

Although duration of the ST elevation varied, in no instance did it exceed 24 hours. In addition, no

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