Case report: Severe hypercalcemia mimicking ST-segment elevation myocardial infarction
Robert C Schutt1, John Bibawy1, Mina Elnemr1
1Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
Methodist Debakey Cardiovascular Journal
|January 10, 2015
Insights
ST-segment elevation on ECGs can indicate cardiac issues, but may also signal noncardiac causes like hypercalcemia. This case highlights hypercalcemia as a cause of ST-segment elevation in a cancer patient.
Area of Science:
- Cardiology
- Oncology
- Internal Medicine
Background:
- ST-segment elevation on electrocardiograms (ECGs) is crucial for diagnosing acute myocardial infarction.
- However, ST-segment elevation can be mimicked by various non-ischemic cardiac and non-cardiac conditions.
- Recognizing these mimics is essential for appropriate patient management and avoiding unnecessary interventions.
Observation:
- A patient with metastatic cancer presented with symptoms suggestive of cardiac ischemia.
- Electrocardiogram revealed ST-segment elevation, a finding typically associated with acute coronary syndromes.
- Laboratory investigations identified significant hypercalcemia as the underlying cause.
Findings:
- The ST-segment elevation was directly attributed to severe hypercalcemia, not cardiac ischemia.
- This case demonstrates a rare but critical non-cardiac cause of a significant ECG finding.
- Metastatic cancer was the likely driver of the electrolyte disturbance.
Implications:
- Clinicians must consider electrolyte abnormalities, particularly hypercalcemia, in the differential diagnosis of ST-segment elevation.
- Prompt identification and management of hypercalcemia can prevent misdiagnosis of acute myocardial infarction.
- This underscores the importance of a comprehensive diagnostic approach in patients with complex medical histories, including those with cancer.
Abstract:
The identification of ST-segment elevation on the electrocardiogram is an integral part of decision making in patients who present with suspected ischemia. Unfortunately, ST-segment elevation is nonspecific and may be caused by noncardiac causes such as electrolyte abnormalities. We present a case of ST-segment elevation secondary to hypercalcemia in a patient with metastatic cancer.
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