Release of Sengstaken-Blakemore tube traction resulted in immediate and complete resolution of inferior ST-segment elevation, suggesting mechanical compression of the posterior descending artery.
Case Report (n=1)
Sengstaken-Blakemore tube traction can cause a reversible inferior STEMI pattern due to mechanical compression of the posterior descending artery, which resolves immediately upon traction release.
Abstract Introduction ST-segment elevation (STE) is typically associated with acute coronary syndrome, but not all EKG patterns demonstrating STE are caused by intra-arterial blockage. We present a rare case of reversible inferior STEMI caused by external compression from a Sengstaken-Blakemore tube (SBT) in a patient with a clean left heart catheterization. Description An 86-year-old man with a history of cirrhosis, hepatocellular carcinoma, and gastric varices presented for outpatient variceal banding. His procedure was complicated by acute variceal bleeding and a failed banding attempt. An SBT was placed with the gastric balloon inflated with 400 mL of air. Traction was applied with a 1-L normal saline bag. The bleeding was then controlled, with stable hemodynamics and hemoglobin levels. The SBT traction was continued. Approximately 40 hours later, telemetry revealed new onset ST-segment elevation (STE). A 12-lead EKG confirmed STE in leads II, III, and aVF, with reciprocal depressions in precordial leads. However, a repeat EKG immediately after releasing SBT traction (within one minute) showed complete resolution of the inferior STEMI. Emergent catheterization revealed a left-dominant coronary circulation with no obstructive coronary artery disease. Serial high-sensitivity troponins remained undetectable. The patient was eventually discharged to rehabilitation without further cardiac events. Discussion Given the anatomy and inferior STE pattern, the presumed mechanism is mechanical compression of the posterior descending artery. While transient EKG changes associated with gastrointestinal (GI) procedures have been reported, there are few documented cases of immediate, complete resolution of inferior STE after SBT traction removal. This case highlights the importance of early recognition of this rare complication, as prolonged external compression of a coronary artery due to SBT traction can quickly lead to morbidity and mortality, as seen in acute coronary syndrome. This abstract is funded by: None
Bahadur et al. (2026) conducted a case report in Transient inferior STEMI (n=1). Sengstaken-Blakemore tube traction release was evaluated on Resolution of inferior STEMI. Release of Sengstaken-Blakemore tube traction resulted in immediate and complete resolution of inferior ST-segment elevation, suggesting mechanical compression of the posterior descending artery.