{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:34:34Z","timestamp":1789468474792,"version":"build-2803163510"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Acute coronary syndrome (ACS) remains a leading global cause of morbidity and mortality. Healthcare systems worldwide have established national guidelines to facilitate the timely identification and transfer of patients with ST-elevation myocardial infarction (STEMI) to centers capable of performing primary percutaneous coronary intervention (PCI). Typically, ST-segment elevation (STE) on an electrocardiogram (ECG) is indicative of STEMI, prompting early intervention. However, rare cases of STE have been documented in the setting of sepsis or septic shock, with subsequent coronary angiography or imaging revealing normal coronary arteries. There is limited information regarding the exact mechanisms responsible for STE in the context of sepsis. We report the case of a 79-year-old Indian female who presented with epigastric pain and vomiting. Her initial ECG showed STE in leads I, aVL, and V2, accompanied by markedly elevated cardiac biomarkers. In accordance with the national STEMI network protocol, she received prehospital dual antiplatelet therapy and intravenous heparin before hospital arrival and was transferred directly for primary PCI. She was initially managed as a case of ACS; however, coronary angiography demonstrated normal coronary arteries. Further evaluation led to the diagnosis of septic shock secondary to extended-spectrum beta-lactamase (ESBL)-producing\n                    <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                    urosepsis, requiring mechanical ventilation, four concurrent vasopressors, and continuous venovenous hemodiafiltration, with complete clinical recovery. Notably, her ECG abnormalities resolved within 72 h following prompt management of the septic shock. While STEMI remains the most common cause of STE on ECG, sepsis and septic shock are rare but important differential diagnoses. The underlying pathophysiology may involve inflammatory myocardial injury, transient coronary vasospasm, or global hypoperfusion. This case highlights the critical importance of recognizing septic shock as a potentially life-threatening STEMI mimic, to avoid unnecessary invasive interventions and to guide appropriate, targeted management.\n                  <\/jats:p>","DOI":"10.4103\/heartviews.heartviews_18_26","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T09:01:31Z","timestamp":1789462891000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["A Diagnostic Dilemma: Urosepsis Mimicking ST-elevation Myocardial Infarction: A Case Report and Review of the Literature"],"prefix":"10.4103","volume":"27","author":[{"given":"Mohamed","family":"Atta","sequence":"first","affiliation":[{"name":"Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Ashour","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Khazaal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Rahman","family":"Arabi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhd Baraa","family":"Habib","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2]]},"reference":[{"key":"R1-20260915","doi-asserted-by":"crossref","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Critical Care Med"},{"key":"R2-20260915","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1164\/rccm.201504-0781OC","article-title":"Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations","volume":"193","author":"Fleischmann","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"key":"R3-20260915","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1001\/jama.2016.0288","article-title":"Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Seymour","year":"2016","journal-title":"JAMA"},{"key":"R4-20260915","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"R5-20260915","doi-asserted-by":"crossref","first-page":"743","DOI":"10.12998\/wjcc.v3.i8.743","article-title":"When sepsis affects the heart: A case report and literature review","volume":"3","author":"Clemente","year":"2015","journal-title":"World J Clin Cases"},{"key":"R6-20260915","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1378\/chest.129.5.1349","article-title":"Sepsis-associated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides","volume":"129","author":"Maeder","year":"2006","journal-title":"Chest"},{"key":"R7-20260915","doi-asserted-by":"crossref","first-page":"e004040","DOI":"10.1161\/CIRCOUTCOMES.117.004040","article-title":"Myocardial injury in patients with sepsis and its association with long-term outcome","volume":"11","author":"Frencken","year":"2018","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"R8-20260915","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1093\/eurheartj\/ehr351","article-title":"Diastolic dysfunction and mortality in severe sepsis and septic shock","volume":"33","author":"Landesberg","year":"2012","journal-title":"Eur Heart J"},{"key":"R9-20260915","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1159\/000063120","article-title":"ECG changes during septic shock","volume":"97","author":"Rich","year":"2002","journal-title":"Cardiology"},{"key":"R10-20260915","first-page":"8879878","article-title":"ST-elevation myocardial infarction in the presence of septic shock","author":"Ishmael","year":"2020","journal-title":"Case Rep Crit Care 2020"},{"key":"R11-20260915","doi-asserted-by":"crossref","first-page":"102","DOI":"10.3810\/pgm.2009.03.1981","article-title":"Escherichia coli septic shock masquerading as ST-segment elevation myocardial infarction","volume":"121","author":"Martinez","year":"2009","journal-title":"Postgrad Med"},{"key":"R12-20260915","doi-asserted-by":"crossref","first-page":"208.e5","DOI":"10.1016\/j.ajem.2023.06.038","article-title":"Emphysematous pyelonephritis with ST elevation accompanied by reciprocal changes mimicking acute coronary syndrome","volume":"70","author":"Hatakeyama","year":"2023","journal-title":"Am J Emerg Med"},{"key":"R13-20260915","doi-asserted-by":"crossref","first-page":"e41454","DOI":"10.1097\/MD.0000000000041454","article-title":"Septic cardiomyopathy or myocardial infarction? A case report of septic shock with ST-segment elevation on ECG","volume":"104","author":"Gao","year":"2025","journal-title":"Medicine (Baltimore)"},{"key":"R14-20260915","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1093\/postmj\/qgad024","article-title":"The association between mortality and door-to-antibiotic time: A systematic review and meta-analysis","volume":"99","author":"Huang","year":"2023","journal-title":"Postgrad Med J"},{"key":"R15-20260915","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1016\/S0735-1097(03)00421-2","article-title":"Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes","volume":"41","author":"Ammann","year":"2003","journal-title":"J Am Coll Cardiol"},{"key":"R16-20260915","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1161\/CIRCULATIONAHA.106.613596","article-title":"Cardiogenic shock: Current concepts and improving outcomes","volume":"117","author":"Reynolds","year":"2008","journal-title":"Circulation"},{"key":"R17-20260915","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.chest.2018.08.1037","article-title":"The septic heart: Current understanding of molecular mechanisms and clinical implications","volume":"155","author":"Martin","year":"2019","journal-title":"Chest"},{"key":"R18-20260915","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40560-016-0148-1","article-title":"Sepsis-induced myocardial dysfunction: Pathophysiology and management","volume":"4","author":"Kakihana","year":"2016","journal-title":"J Intensive Care"},{"key":"R19-20260915","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-013-2902-3","article-title":"Prognostic value of troponins in sepsis: A meta-analysis","volume":"39","author":"Bessi\u00e8re","year":"2013","journal-title":"Intensive Care Med"},{"key":"R20-20260915","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1001\/archinte.166.22.2446","article-title":"Elevated cardiac troponin measurements in critically ill patients","volume":"166","author":"Lim","year":"2006","journal-title":"Arch Intern Med"},{"key":"R21-20260915","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.jacc.2007.03.050","article-title":"Four-year recurrence rate and prognosis of the apical ballooning syndrome","volume":"50","author":"Elesber","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"R22-20260915","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/1752-1947-3-109","article-title":"Tenecteplase for ST-elevation myocardial infarction in a patient treated with drotrecogin alfa (activated) for severe sepsis: A case report","volume":"3","author":"Barra","year":"2009","journal-title":"J Med Case Rep"}],"container-title":["Heart Views"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/heartviews.heartviews_18_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T09:01:33Z","timestamp":1789462893000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/heartviews.heartviews_18_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/heartviews.heartviews_18_26","relation":{},"ISSN":["1995-705X","0976-5123"],"issn-type":[{"value":"1995-705X","type":"print"},{"value":"0976-5123","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"2026-01-29","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}