Not all ST-segment changes are myocardial injury: hypercalcaemia-induced ST-segment elevation.

Area of Science:

• Cardiology
• Internal Medicine
• Oncology

Background:

• ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring rapid diagnosis and treatment.
• Elderly patients with multiple comorbidities present diagnostic challenges.

Observation:

• An 83-year-old male with coronary artery disease and multiple myeloma presented with ECG changes suggestive of anterior STEMI.
• Initial troponins were negative, but serum calcium was significantly elevated at 3.55 mmol/L.

Findings:

• ECG abnormalities, including ST-segment elevation, were attributed to severe hypercalcemia rather than acute cardiac ischemia.
• Treatment with fluids, diuretics, and zolendronic acid led to the resolution of ECG changes.

Implications:

• Clinicians should consider non-ischemic causes, such as hypercalcemia, for ST-segment changes, especially when clinical presentation is atypical.
• Differentiating hypercalcemia-induced ECG changes from STEMI is crucial to prevent unnecessary and potentially harmful invasive procedures.