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ST elevation due to hypercalcemia.

Edward Durant1, Amandeep Singh2

  • 1Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States.

The American Journal of Emergency Medicine
|February 18, 2017
PubMed
Summary
This summary is machine-generated.

Severe hypercalcemia can cause dangerous ECG changes, including ST elevation that mimics heart attacks. This case highlights the importance of checking calcium levels in patients with unexplained ECG abnormalities.

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Area of Science:

  • Cardiology
  • Endocrinology
  • Medical Diagnostics

Background:

  • Hypercalcemia, a condition of elevated serum calcium, presents with characteristic electrocardiogram (ECG) changes.
  • These changes typically include shortened QTc intervals and, at very high levels, PR and QRS prolongation, T-wave abnormalities, and J waves.

Observation:

  • A 22-year-old male, immobilized for 5 months post-trauma, presented with ECG findings of shortened QoT and QaT intervals.
  • These ECG abnormalities mimicked anterior ST-elevation myocardial infarction.
  • Laboratory results revealed severe hypercalcemia (15 mg/dL).

Findings:

  • The patient's ST elevation was attributed to hypercalcemia, not acute myocardial infarction, as confirmed by negative troponin levels.
  • This case underscores the potential for hypercalcemia to induce ST elevation, a critical diagnostic consideration.
  • Literature review confirms the association between hypercalcemia and ST elevation.

Implications:

  • Prompt recognition of hypercalcemia is crucial in patients presenting with ST elevation and no clear cardiac cause.
  • Measuring serum calcium levels should be considered in the differential diagnosis of ST elevation on ECG.
  • Understanding the ECG manifestations of hypercalcemia can prevent misdiagnosis and guide appropriate management.