{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T17:57:04Z","timestamp":1781459824100,"version":"3.54.1"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medical Case Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>ST-segment elevation on electrocardiography is classically associated with acute myocardial infarction and often prompts urgent invasive evaluation. However, non-ischemic causes may complicate diagnostic decision-making, particularly in elderly patients with acute non-cardiac illnesses. We report a 95-year-old woman admitted with COVID-19\u2013associated pneumonia and aspiration pneumonia, whose admission electrocardiogram demonstrated ST-segment elevation with T-wave inversion in the lateral precordial leads, mimicking ST-elevation myocardial infarction. She had no chest pain, no elevation of cardiac biomarkers, and preserved left ventricular systolic function without regional wall motion abnormalities on echocardiography. Review of prior records revealed that similar electrocardiographic abnormalities had been consistently present for more than a decade. Serial imaging demonstrated no overt structural heart disease. However, the electrocardiographic pattern\u2014localized and persistent ST-segment elevation with repolarization abnormalities\u2014is most consistent with chronic localized myocardial remodeling, possibly related to unrecognized myocardial fibrosis. This case highlights the importance of integrating clinical presentation, biomarkers, and longitudinal electrocardiographic findings. Persistent ST-segment elevation does not always indicate acute coronary occlusion, but may reflect an underlying structural myocardial substrate not detectable by routine imaging.<\/jats:p>","DOI":"10.1177\/2050313x261458029","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T10:20:07Z","timestamp":1781173207000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent ST-segment elevation mimicking ST-elevation myocardial infarction"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8323-4229","authenticated-orcid":false,"given":"Yoshiyasu","family":"Aizawa","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan"},{"name":"Department of Internal Medicine, Kin-ikyo Tomakomai Hospital, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takumi","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kin-ikyo Tomakomai Hospital, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000617"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx393"},{"issue":"4","key":"e_1_3_2_4_2","first-page":"319","article-title":"ECG diagnosis and classification of acute myocardial ischemia","volume":"19","author":"Birnbaum Y","year":"2014","unstructured":"Birnbaum Y, Wilson JM, Fiol M, et al. ECG diagnosis and classification of acute myocardial ischemia. Ann Noninvasive Electrocardiol 2014; 19(4): 319\u2013329.","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.4103\/tjem.tjem_137_24"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra022580"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101314"},{"issue":"22","key":"e_1_3_2_8_2","article-title":"2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR guideline for the evaluation and diagnosis of chest pain","volume":"144","author":"Gulati M","year":"2021","unstructured":"Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR guideline for the evaluation and diagnosis of chest pain. Circulation 2021; 144(22): e368\u2013e454.","journal-title":"Circulation"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2005.08.008"},{"key":"e_1_3_2_10_2","volume-title":"Chou\u2019s electrocardiography in clinical practice","author":"Surawicz B","year":"2008","unstructured":"Surawicz B, Knilans TK. Chou\u2019s electrocardiography in clinical practice. 6th ed. Saunders Elsevier, 2008.","edition":"6"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101214"},{"issue":"4","key":"e_1_3_2_12_2","first-page":"455","article-title":"Update on myocarditis: what we know so far and where we may be heading","volume":"10","author":"Rroku A","year":"2021","unstructured":"Rroku A, Kottwitz J, Heidecker B. Update on myocarditis: what we know so far and where we may be heading. Eur Heart J Acute Cardiovasc Care 2021; 10(4): 455\u2013467.","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.04.014"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.05.033"},{"issue":"4","key":"e_1_3_2_15_2","article-title":"2013 ACCF\/AHA guideline for the diagnosis and management of patients with pericardial disease","volume":"128","author":"Klein AL","year":"2013","unstructured":"Klein AL, Abbara S, Agler DA, et al. 2013 ACCF\/AHA guideline for the diagnosis and management of patients with pericardial disease. Circulation 2013; 128(4): e154\u2013e209.","journal-title":"Circulation"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-306362"},{"issue":"15","key":"e_1_3_2_17_2","first-page":"1202","article-title":"Current state of knowledge on Takotsubo syndrome","volume":"37","author":"Lyon AR","year":"2016","unstructured":"Lyon AR, Bossone E, Schneider B, et al. Current state of knowledge on Takotsubo syndrome. Eur Heart J 2016; 37(15): 1202\u20131211.","journal-title":"Eur Heart J"}],"container-title":["Sage Open Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261458029","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2050313X261458029","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261458029","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T17:09:18Z","timestamp":1781456958000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2050313X261458029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":16,"alternative-id":["10.1177\/2050313X261458029"],"URL":"https:\/\/doi.org\/10.1177\/2050313x261458029","relation":{},"ISSN":["2050-313X","2050-313X"],"issn-type":[{"value":"2050-313X","type":"print"},{"value":"2050-313X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"2050313X261458029"}}