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DKA-induced Brugada phenocopy mimicking STEMI.

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Diabetic ketoacidosis (DKA) can mimic cardiac events, causing ST elevations on ECG. Prompt DKA treatment resolved these changes, indicating no underlying cardiac pathology. This case highlights the importance of considering metabolic derangements in cardiac presentations.

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Area of Science:

  • Cardiology
  • Endocrinology
  • Internal Medicine

Background:

  • Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus.
  • DKA can present with symptoms that mimic acute cardiac events, including ECG changes.
  • Misdiagnosis can lead to unnecessary invasive procedures and treatments.

Purpose of the Study:

  • To present a case where diabetic ketoacidosis mimicked ST-elevation myocardial infarction.
  • To emphasize the importance of considering metabolic derangements in patients with cardiac symptoms.
  • To illustrate the resolution of cardiac changes upon correction of DKA.

Main Methods:

  • A 47-year-old woman with type 1 diabetes and poor adherence presented with epigastric pain and vomiting.
  • Initial ECG showed ST elevations (V1-V3) and T wave inversions.
  • Biochemistry revealed severe DKA with hyperglycemia, metabolic acidosis, and elevated CKMB; cardiac catheterization was normal.

Main Results:

  • DKA was diagnosed and treated, with resolution of symptoms and ECG changes within 8 hours.
  • Serial troponin levels were negative, and cardiac catheterization showed normal coronary anatomy.
  • The patient had no episodes of ventricular tachycardia or fibrillation during monitoring.

Conclusions:

  • ECG changes in DKA can be transient and reversible with DKA treatment.
  • It is crucial to rule out metabolic causes, such as DKA, in patients presenting with acute cardiac symptoms and ECG abnormalities.
  • Aggressive management of DKA is essential to prevent potentially life-threatening cardiac complications.