Acute ST segment elevation secondary to acute gastric distention

An adolescent male trauma patient developed new asymptomatic ST segment elevations that mimicked a myocardial infarction on infero-lateral telemetry leads on hospital day #8, following burn excision and skin grafting. This was confirmed on 12 lead electrocardiogram. Laboratory test results indicated normal potassium. Troponins ×3 were negative. X-rays indicated marked gaseous gastric distention. A nasogastric tube was placed with evacuation of 400 mL of fluid and resolution of gastric distention. After gastric decompression, the ST segment elevations resolved. This case illustrates the need to consider acute gastric distention in the differential of acute ST segment elevation.