Emphysematous gastritis presenting as a Pseudo–inferior myocardial infarction due to cardiac displacement

Abstract

This case explores emphysematous gastritis manifesting as transient inferior ST-segment elevation on electrocardiogram (ECG), mimicking acute myocardial infarction. The patient presented with symptoms and ECG findings initially concerning for inferior wall myocardial infarction. Negative cardiac biomarkers, normal echocardiography, and resolution of ECG abnormalities following gastric decompression supported an extracardiac etiology. Emphysematous gastritis is an uncommon but life-threatening condition, with fewer than 100 cases reported, and no previous description of causing a pseudo-infarction pattern on ECG. This case highlights the importance of recognizing extracardiac causes of ST-segment elevation and integrating clinical context, biomarkers, and imaging to avoid unnecessary invasive cardiac intervention.