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Published on: May 28, 2019
ST segment elevation associated with hydrochloric acid ingestion: A case report
1Department of Emergency Medicine, Kaohsiung Medical University Hospital Institute of Clinical Medicine, College of Medicine School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Insights
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.
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.
Rationale:
Electrocardiography (ECG) was used to diagnose acute coronary syndrome, but many other diseases may also result in ST segment change. We report one case of ingested hydrochloric acid present with ST segment elevation in the ECG. However, subsequent coronary angiography did not reveal significant coronary occlusion.
Patient Concerns:
An 83-year-old female was transferred to our emergency department (ED) from the branch hospital due to ingestion of toilet bowl cleaner containing 9.5% hydrochloric acid. She complained about chest pain and 12-lead ECG showed ST segment elevation at lead II, III, and aVF. The blood examinations revealed elevation of aspartate transaminase (69 IU/L), thrombocytopenia (62,000/μL), and acidosis (pH 7.311, pCO2 27 mm Hg, HCO3 13.3 mmol/L). Creatine kinase-MB and troponin I did not elevate then.
Diagnoses:
After transferred to our ED, coronary angiography was done within 1 hour. Angiography showed 60% stenosis in the segment 7 of left anterior descending coronary artery and 30% nonsignificant stenosis in the segment 2 of right coronary artery, with no apical ballooning. No significant lesion consistent with ST segment elevation myocardial infarction was found.
Interventions:
Conservative treatment was chosen.
Outcomes:
Bradycardia was followed by cardiac arrest that developed 4 hours later. Cardiopulmonary resuscitation was applied and the patient became shock status after return of spontaneous circulation. The patient was admitted to the intensive care unit and expired on next day.
Lessons:
Patients of ingested hydrochloric acid present with ST segment elevation in the ECG may not indicate coronary artery disease. This ECG finding may be a poor prognostic index in such patients.
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