{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T20:43:46Z","timestamp":1777322626620,"version":"3.51.4"},"reference-count":11,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Electrocardiographic changes resembling myocardial ischemia are rare in gastrointestinal emergencies. In particular, gastric perforation has been reported in association with ST-segment elevation, but not with ST-segment depression mimicking non-ST-segment elevation myocardial infarction (NSTEMI). We report the case of a 60-year-old woman presenting with sudden-onset epigastric pain radiating to the chest. She remained hemodynamically stable throughout her emergency department stay. On admission, the ECG showed diffuse ST-segment depression with ST-segment elevation in aVR. High-sensitivity troponin and inflammatory markers were within normal limits. Coronary angiography revealed no significant coronary stenosis, and left ventriculography demonstrated preserved left ventricular systolic function. Abdominal computed tomography showed abundant pneumoperitoneum, diffuse anterior gastric wall thickening, and moderate intraperitoneal fluid, findings highly suggestive of gastric perforation. The patient underwent laparoscopic gastric repair and abdominal lavage, with an uneventful postoperative recovery. A repeat ECG 24 h after surgery showed complete resolution of the ST-segment abnormalities. To our knowledge, this is the first reported case of gastric perforation presenting with diffuse ST-segment depression and aVR ST-segment elevation. Awareness of this presentation helps to broaden the spectrum of diagnostic possibilities and to plan appropriate diagnostic\u2013therapeutic procedures.<\/jats:p>","DOI":"10.3390\/diagnostics16091300","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:24:51Z","timestamp":1777317891000},"page":"1300","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unexpected Findings in Diffuse ST-Segment Depression and aVR ST-Segment Elevation"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1376-2510","authenticated-orcid":false,"given":"Mohamed","family":"El Mallouli","sequence":"first","affiliation":[{"name":"Cardiology Department, CHU Brugmann, 1020 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amina","family":"El Bakkali","sequence":"additional","affiliation":[{"name":"Emergency Department, CHU Brugmann, 1020 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usama","family":"Azziz","sequence":"additional","affiliation":[{"name":"Cardiology Department, CHU Brugmann, 1020 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre-Emmanuel","family":"Massart","sequence":"additional","affiliation":[{"name":"Cardiology Department, CHU Namur Sainte Elisabeth, 5000 Namur, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgiana","family":"Pintea Bentea","sequence":"additional","affiliation":[{"name":"Cardiology Department, CHU Namur Sainte Elisabeth, 5000 Namur, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1001\/jama.2012.199","article-title":"Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality","volume":"307","author":"Canto","year":"2012","journal-title":"JAMA"},{"key":"ref_2","first-page":"55","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"13","author":"Byrne","year":"2023","journal-title":"Eur. Hear. Journal. Acute Cardiovasc. Care"},{"key":"ref_3","first-page":"101893","article-title":"The Prognostic-Diagnostic paradox of lead aVR: From \u2018STEMI-Equivalent\u2019 to \u2018High-Risk NOMI\u2019 in the era of precision cardiology","volume":"63","author":"Deng","year":"2026","journal-title":"Int. J. Cardiol. Heart Vasc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e240156","DOI":"10.1136\/bcr-2020-237470","article-title":"Gastric perforation mimicking ST-segment elevation myocardial infarction","volume":"14","author":"Intan","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_5","first-page":"43","article-title":"Perforated gastric ulcer with ST-segment elevation mimicking acute myocardial infarction","volume":"8","author":"Vutthikraivit","year":"2020","journal-title":"Southwest Respir Crit Care Chron."},{"key":"ref_6","first-page":"597","article-title":"Acute gastric perforation mimicking ST-segment elevation myocardial infarction","volume":"76","author":"Broncano","year":"2023","journal-title":"Rev. Esp. Cardiol. (Engl. Ed.)"},{"key":"ref_7","first-page":"218","article-title":"Gastric ulcer perforation into the pericardium presenting as ST-segment elevation myocardial infarction","volume":"31","author":"Hoang","year":"2018","journal-title":"Proc. Bayl. Univ. Med. Cent."},{"key":"ref_8","first-page":"101693","article-title":"Small bowel perforated viscus mimicking inferior wall ST-elevation myocardial infarction","volume":"14","author":"Romero","year":"2024","journal-title":"JACC Case Rep."},{"key":"ref_9","first-page":"1086","article-title":"Gastrointestinal distention masquerading as ST-segment elevation myocardial infarction","volume":"2","author":"Zhang","year":"2020","journal-title":"JACC Case Rep."},{"key":"ref_10","first-page":"6211","article-title":"ST-segment elevation in conditions of non-cardiovascular origin: A narrative review","volume":"11","author":"Khurana","year":"2022","journal-title":"J. Family Med. Prim. Care"},{"key":"ref_11","first-page":"1029","article-title":"ST-segment elevation: Always a marker of acute myocardial infarction?","volume":"167","author":"Coppola","year":"2013","journal-title":"Int. J. Cardiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1300\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:51:31Z","timestamp":1777319491000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":11,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091300"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091300","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]}}}