Abstract
Rationale: Electrolyte disorders is a noteworthy entity in clinical practice. Hypocalcemia is a well-known serious electrolyte disorder. A Wavy triple sign of hypocalcemia (Yasser sign) is a novel an electrocardiographic sign linked to calcium deficiency. Tented T-wave is frequently identified in chronic kidney disease. Hyperkalemia is a lethal metabolic disturbance that may be a result of kidney failure. Patient concerns: An old-aged male carpenter patient presented to the emergency department with hyperventilation syndrome, chest pain, and tetany. Diagnosis: Chronic renal failure-induced hypocalcemia with subsequent a Wavy triple an electrocardiographic sign or Yasser sign. Interventions: Electrocardiography, arterial blood gases, oxygenation, and echocardiography. Lessons: The dramatic reversal of the wavy triple sign of hypocalcemia (Yasser sign) after calcium gluconate injection interpret that these signs were due to hypocalcemia of chronic renal failure. Tented T-wave is not necessary occurs by hyperkalemia. Outcomes: There was a dramatic improvement of both clinical and electrocardiographic wavy triple sign of hypocalcemia after calcium injection.
Highlights
Various qualitative changes due to electrolyte imbalance may be seen on an electrocardiogram (ECG) [1]
An Urgent initial ECG tracing on the emergency room showing normal sinus rhythm with Wavy triple sign of hypocalcemia (Yasser sign) in four leads of ECG V1, 2, 5, and 6) with VR; 66 bpm
The second ECG tracing was taken within 10 minutes after 2 amp of IV calcium therapy showing the disappearance of above Wavy triple sign of hypocalcemia (Yasser sign) but still, there are hyperacute T-wave in V4-6 leads with VR; 68 bpm (Figure 2)
Summary
Various qualitative changes due to electrolyte imbalance may be seen on an electrocardiogram (ECG) [1]. Tall T-waves or hyperacute Twaves are considered an early sign of ST-elevation myocardial infarction (MI) It may be the earliest sign of MI on the ECG. Elevated T-waves can be seen as a normal variant in young athletes, typically in the precordial V2-V4 leads [6]. An Urgent initial ECG tracing on the emergency room showing normal sinus rhythm with Wavy triple sign of hypocalcemia (Yasser sign) in four leads of ECG V1, 2, 5, and 6) with VR; 66 bpm. The second ECG tracing was taken within 10 minutes after 2 amp of IV calcium therapy showing the disappearance of above Wavy triple sign of hypocalcemia (Yasser sign) but still, there are hyperacute T-wave in V4-6 leads with VR; 68 bpm (Figure 2). There are hyperacute T-wave in V4 and 5 leads (gold arrows)
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