Not all ST-segment changes are myocardial injury: hypercalcaemia-induced ST-segment elevation
Adam Orville Strand1, Thein Tun Aung2, Ajay Agarwal3
1Department of Internal Medicine, Wright State University, Dayton, Ohio, USA.
Insights
This case highlights hypercalcemia mimicking ST-segment elevation myocardial infarction (STEMI) in an elderly patient. Prompt recognition and management of hypercalcemia resolved ECG changes, avoiding unnecessary cardiac interventions.
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.
Abstract:
ST-segment elevation myocardial infarction is an important, life-threatening diagnosis that requires quick diagnosis and management. We describe the case of an 83-year-old man with coronary artery disease, ischaemic cardiomyopathy with left ventricular ejection fraction of 15%, newly diagnosed multiple myeloma that had an initial ECG showing ST-segment elevation in anterior leads V1-3 and ST-segment depression in lateral leads concerning for an ST-segment elevation myocardial infarction. Troponins were negative and his calcium was 3.55 mmol/L. It was thought that the ECG changes were not indicative of cardiac ischaemia but, rather, hypercalcaemia. He was treated with fluids, diuretics and zolendronic acid, with subsequent resolution of ST-segment changes. This case demonstrates that one must consider disease other than myocardial ischaemia as the culprit of ST-segment changes if physical examination and history do not point towards myocardial injury, as unnecessary invasive revascularisation procedures have inherent risks.
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