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Gas Wala Pain: An Unusual Association of Acute Gastric Dilatation and Myocardial Infarction
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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00167. Epub July 3, 2024.
Although chest pain is the most common presentation of acute myocardial infarction (MI), the occurrence of unusual symptoms is frequently seen. Inferior wall infarction is associated with more gastrointestinal symptoms, such as nausea, vomiting, and epigastric pain, than anterior infarction. Acute gastrointestinal emergencies such as acute gastric dilatation frequently mimic ST-elevation MI.1 In rare cases, stimulation of cardiac sensory receptors also induces gastric dilatation.2 Thus, it is sometimes difficult to discern the real pathology in atypical presentation, leading to delays in appropriate management.
We present a case of a 59-year-old man with a history of diabetes, hypertension, and obesity, who reported having chest pain 3 days prior to his presentation in our institute. During evaluation, his routine blood investigations, including renal function tests and complete blood count, were normal. Electrocardiogram (ECG) showed ST elevation in V1 to V3 for which thrombolysis was done with streptokinase, resulting in the resolution of ST segment elevation. He became pain-free and was sent for further evaluation. He was planned for coronary angiography; however, he had another episode of acute chest discomfort. The cath lab team was activated immediately for coronary angiography and potential revascularization. In the cath lab, he reported “gas wala pain,” which is an idiosyncratic way of a lay person in North India to describe pain and discomfort in the chest which they assume is being caused by gastric bloating or “gas”.
On fluoroscopy, his stomach was dilated significantly; however, there was no vomiting, and he was passing voluminous flatus, so we did not suspect any obstruction in the gut (Figure 1). He had never experienced these kinds of abdominal symptoms prior to this illness. On coronary angiogram, his left anterior descending and left circumflex arteries were almost normal with codominant circulation. His right coronary artery (RCA) was occluded in the mid-segment (Figure 2). He had a brief episode of ventricular tachycardia, which was reverted with direct current cardioversion and a short-duration cardiopulmonary resuscitation. ECG showed that the right ventricle was mildly dilated with thinning, as well as a small aneurysmal bulge in the basal wall. He underwent percutaneous transluminal coronary angioplasty and stenting in the RCA. His subsequent stay in the hospital was uneventful. The next day, an X-ray was performed on his abdomen, which was grossly normal without any features of obstruction.
As demonstrated by this case, it is imperative to complete a comprehensive analysis of a disease by evaluating all symptoms and signs and conduct relevant investigations with utmost detail. Here, the cardiac enzymes and ECG were of utmost importance in establishing the presence of coronary artery disease as the etiology of the patient’s symptoms and ECG changes.
Affiliations and Disclosures
Neelam Dahiya, MD, DM; Somyata Somendra, MD, MRCP
From the Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.
Consent statement: The authors confirm that informed consent was obtained from the patient for the interventions described in the manuscript and to the publication thereof.
Address for correspondence: Somyata Somendra, MD, MRCP UK, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Email: somyatasomendra1@gmail.com
References
- Avidan Y, Tabachnikov V, Aker A. Gastric dilatation masquerading as anterolateral ST-elevation myocardial infarction. Cureus. 2023;15(7):e41442. doi: 10.7759/cureus.41442
- Johannsen, UJ. Summers R, Mark AL. Gastric dilation during stimulation of cardiac sensory receptors. Circulation. 1981;63:4.
