ST elevation in a patient with small bowel occlusion and gastric distension—What is the most likely explanation? A hypothesis generating case report

Abstract We report a case of ST segment elevation and PR depression in inferolateral leads in a patient with small bowel occlusion and gastric distension that disappeared immediately after gastric evacuation. Contrary to prior reports, we believe that these ECG changes do not represent an intrinsic cardiac electrical abnormality, but are likely artefactual. We hypothesise that the accumulated air between the heart, lower limbs and left precordial electrodes result in a significant departure from the simplified assumptions of standard 12 lead ECG analysis (that the electrical activity of the heart can be described by an electrical dipole at a fixed location in an electrical homogeneous sphere) in such a way that the ECG filtering process will not compensate for this bias and will artificially create the ECG pattern described in this report.