Abstract
IntroductionA rare electrocardiographic finding of hyperkalemia is ST segment elevation or the so called 'pseudoinfarction' pattern. It has been suggested that hyperkalemia causes the 'pseudoinfarction' pattern not only through its direct myocardial effects, but also through other mechanisms, such as anoxia, acidosis, and coronary artery spasm.Case presentationA 33-year-old Caucasian woman with insulin-treated diabetes presented with continuous epigastric pain of four hours duration. Her coronary heart disease risk factors apart from diabetes included hypercholesterolemia and smoking. Her initial electrocardiogram revealed ST segment elevation in the anteroseptal leads consistent with anterior myocardial infarction. Blood tests revealed hyperglycemia, hyperkalemia, metabolic acidosis and urine ketones, while a bed-side cardiac echocardiogram showed no segmental wall motion abnormality. We provisionally diagnosed diabetic ketoacidosis that was possibly precipitated by acute myocardial infarction, as there were findings in favor of (epigastric pain, electrocardiogram pattern, presence of 3 coronary heart disease risk factors) and against (young age, normal echocardiogram) the diagnosis of acute myocardial infarction. We performed cardiac angiography in order to exclude an anterior acute myocardial infarction, which could lead to myocardial damage and possible severe complications should there be a delay in treatment. Angiography revealed normal coronary arteries. During the procedure, ST segment elevation in the anteroseptal leads was still present in our patient's electrocardiogram results.ConclusionST segment elevation is a rare manifestation of hyperkalemia. In our patient, coronary spasm did not contribute to such an electrocardiography finding.
Highlights
A rare electrocardiographic finding of hyperkalemia is ST segment elevation or the so called 'pseudoinfarction' pattern
It has been reported that hyperkalemia can rarely produce abnormal ST segment elevation simulating an acute myocardial infarction [1,2,3,4,5,6,7]
We present the case of a patient with diabetic ketoacidosis and hyperkalemia whose initial ECG showed a pseudoinfarction pattern, but an urgent coronary angiogram revealed normal coronary arteries
Summary
It has been reported that hyperkalemia can rarely produce abnormal ST segment elevation simulating an acute myocardial infarction [1,2,3,4,5,6,7]. We present the case of a patient with diabetic ketoacidosis and hyperkalemia whose initial ECG showed a pseudoinfarction pattern, but an urgent coronary angiogram revealed normal coronary arteries. Case presentation A 33-year-old Caucasian Greek woman presented to the emergency department of the Hospital with a continuous epigastric pain of four hours duration and intermittent vomiting Her medical history included hypercholesterolemia and type 1 diabetes for 16 years treated with insulin injections twice daily. A repeat ECG showed a complete resolution of the anteroseptal ST segment elevation and intraventricular conduction delay (Figure 1B). Her troponin I concentration 12 hours after admission was normal (0.1 μg/L). When she was discharged seven days after, both her ECG and biochemical results were normal
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