Strangulation: A Cause or Mimicker of Global Myocardial Hypoxia on ECG

ST segment changes are often associated with myocardial ischemia but may be mimickers. We present a 21-year-old male who suffered a cardiac arrest following a suicide attempt by strangulation. Initial ECG revealed diffuse ST depressions and ST elevation in augmented vector right (aVR), concerning myocardial ischemia. However, repeat ECG revealed normal ST segments and an echocardiogram revealed no wall motion abnormalities. This case highlights the effects of systemic hypoxia on cardiac muscle and the need for a broad differential diagnosis when interpreting an ECG. This is invaluable when ST segment changes mimic acute myocardial infarction, but the clinical scenario suggests global hypoxia.