Deep inspiration as a diagnostic maneuver to differentiate accessory pathway-induced ST elevation from inferior myocardial infarction: A case report

Abstract

The Wolff-Parkinson-White (WPW) pattern is an electrocardiographic finding resulting from conduction via an accessory pathway, which can mimic acute myocardial infarction (AMI), particularly when negative delta waves resemble Q waves and the repolarization abnormalities cause ST-segment elevations that mimic STEMI. We report the case of a 65-year-old woman who presented with acute retrosternal chest pain and an ECG showing both delta waves and inferior ST-segment elevations, raising concern for possible MI. However, a deep inspiration maneuver, known to influence autonomic tone, led to partial resolution of the delta waves and ST elevations, suggesting a non-ischemic etiology. Coronary angiography revealed normal coronary arteries, and upper endoscopy ultimately identified severe gastropathy and Helicobacter pylori infection as the cause of her symptoms. The patient was successfully treated with lansoprazole and antibiotics and remained symptom-free on follow-up. This case highlights the potential diagnostic utility of deep inspiration in differentiating accessory pathway-mediated ST changes from those of true myocardial infarction.