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Ingesting hydrochloric acid can cause ST segment elevation on an electrocardiogram (ECG), mimicking a heart attack. This ECG finding in acid ingestion cases may indicate a poor prognosis, unrelated to coronary artery disease.

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Area of Science:

  • Toxicology
  • Cardiology
  • Emergency Medicine

Background:

  • Electrocardiography (ECG) is crucial for diagnosing acute coronary syndrome, but ST segment changes can occur in various conditions.
  • Hydrochloric acid ingestion is a rare but serious event that can present with cardiac symptoms.

Observation:

  • An 83-year-old female ingested toilet bowl cleaner containing hydrochloric acid, presenting with chest pain and ST segment elevation on ECG.
  • Initial blood work showed elevated aspartate transaminase, thrombocytopenia, and acidosis, but cardiac enzymes (CK-MB, troponin I) were not elevated.
  • Coronary angiography revealed non-significant coronary artery stenosis, ruling out acute myocardial infarction as the cause of ECG changes.

Findings:

  • Despite conservative management, the patient experienced bradycardia, cardiac arrest, and shock, ultimately expiring.
  • The ST segment elevation on ECG in this case was not indicative of coronary artery occlusion.

Implications:

  • ST segment elevation in patients with hydrochloric acid ingestion may not signify coronary artery disease.
  • This ECG finding could be a marker of poor prognosis in patients with toxic ingestions, necessitating careful clinical correlation and management.