MASSIVE ST-SEGMENT ELEVATION WITHOUT MYOCARDIAL INJURY IN A PATIENT WITH FULMINANT HEPATIC-FAILURE AND CEREBRAL EDEMA

A 49-year-old woman presented in fulminant hepatic failure. The ECG showed dramatic ST-segment elevation, suggesting diffuse myocardial injury. However, echocardiography, creatine phosphokinase enzyme determinations, and examination of the heart at autopsy (six days later) failed to demonstrate any physiologic, anatomic, or histologic evidence of abnormality. The appearance of ST-segment elevation in this setting should not prompt treatment for cardiac disease or limit the candidacy for liver transplantation of such critically ill patients.