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HERDIN Record #: PCHRD17073109525918 Submitted: 31 July 2017 Modified: 02 August 2017

ST-segment elevation in acute cholecystitis with uncontrolled hyperthyroidism.

Joanavi  M. Ordoña-Miranda,
Sharon Rose Mortel,
Daisy  A. Jarcia

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SYNOPSIS: A variety of non-cardiac conditions have been reported to present with ischemic heart disease clinically and electrocardiographically like cholecystitis which leads to nonspecific T-wave inversions or ST-segment depressions, rarely  it  leads  to  ST-segment  elevation.
CLINICAL PRESENTATION: We  report  a  case  of  a  58-year-old,male,  hypertensive,  diabetic,  and  with  hyperthyroidism on  medication.  Patient  presents  with  two  weeks history of  epigastric  pain  associated  with  nausea  and  vomiting.Symptoms spontaneously resolved until one day prior to admission  patient  developed  persistent  abdominal  pain.Patient  was  seen  at  a  local  hospital  wherein  work-up was  done  which  showed  leukocytosis  on  CBC, hydrops of  gallbladder  on  ultrasound. Further work-up were anteroseptal wall ST elevation on ECG with negative cardiac enzymes. Patient was advised transfer to our institution. 
PHYSICAL FINDINGS: Pertinent  Physical  exam  includes tachycardia, epigastric tenderness and positive Murphy's sign. During the course, patient developed fever and jaundice. 
LABORATORY WORK-UP: Repeat CBC still showed leukocytosis with  neutrophilia.  Repeat  electrocardiogram  showed anteroseptal  wall  ST  elevation  with  negative  Troponin.Echocardiogram showed adequate ejection fraction and adequate  wall  motion  contractility.Thyroid  function  test showed  increased  FT4  and  decreased  TSH.
TREATMENT: Patient was initially started with acute coronary syndrome  regimen.  Antibiotics  were  initiated  and  anti-thyroid and anti-diabetes drugs were adjusted accordingly.There  was  noted  progressive  abdominal  pain; hence, patient  was  referred  to  surgery.  Patient  was  cardio-pulmonary  and  endocrinologically  prepared  and  cleared  for  the  procedure.    Patient  tolerated  the  procedure.
OUTCOME: Patient  was  discharged  improved  with  noted improvement  of  the  electrocardiogram.

Publication Type
Publication Sub Type
Case report
Philippine Journal of Internal Medicine
Publication Date
January-March 2017
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