Key result
Primary PCI restores TIMI 3 flow and achieves ~60% LVEF in young inferior STEMI.
Why the study?
Atypical presentations of acute myocardial infarction with gastrointestinal symptoms such as epigastric pain and vomiting can mimic primary abdominal pathology and lead to diagnostic delay, particularly in young adults perceived to have a low cardiovascular risk.
Case Report (n=1)
No
Inferior ST-elevation myocardial infarction can present solely with gastrointestinal symptoms such as epigastric pain and vomiting in young adults, underscoring the necessity of early electrocardiographic evaluation to enable timely primary PCI.
Answers are grounded in this paper and cite their sources.
May support ECG for epigastric pain in young adults; single case leaves open incidence and generalizability.
Acute myocardial infarction classically presents with chest pain; however, atypical presentations without chest discomfort may lead to diagnostic delay and increased morbidity. Gastrointestinal symptoms such as epigastric pain and vomiting can mimic primary abdominal pathology, particularly in young adults perceived to have a low cardiovascular risk. A 29-year-old male presented to the emergency department with six hours of severe epigastric pain (8/10 intensity) accompanied by recurrent vomiting. He denied chest pain or dyspnoea. Electrocardiography demonstrated 2–3 mm ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. High-sensitivity troponin I levels were markedly elevated. Emergent coronary angiography revealed a complete thrombotic occlusion of the proximal right coronary artery. The patient underwent successful primary percutaneous coronary intervention with deployment of a drug-eluting stent, restoring TIMI grade 3 coronary flow. Inferior ST-elevation myocardial infarction may present solely with gastrointestinal symptoms even in young adults. Early electrocardiography remains essential in patients presenting with unexplained epigastric pain to prevent delayed reperfusion and adverse outcomes.
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Moses Phiri (2026) conducted a case report in Acute inferior ST-elevation myocardial infarction (STEMI) presenting with atypical gastrointestinal symptoms (n=1). Primary percutaneous coronary intervention (PCI) with everolimus-eluting drug-eluting stent and guideline-directed medical therapy was evaluated on Coronary reperfusion (TIMI grade 3 flow), symptom resolution, and left ventricular ejection fraction at 6 months. Primary PCI with an everolimus-eluting stent restored TIMI 3 flow in a 29-year-old male with inferior STEMI mimicking epigastric pain, achieving complete symptom resolution and 60% LVEF at 6 months.
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