Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the
Ashraf Abugroun1, Aneesh Tyle2, Farah Faizan3
1Wayne State University, Detroit, Michigan, USA.
Insights
Severe hypercalcemia can mimic heart attack symptoms on an electrocardiogram (EKG). This case highlights the importance of checking calcium levels in patients with ST-segment elevation and no acute coronary syndrome.
Area of Science:
- Cardiology
- Oncology
- Endocrinology
Background:
- ST-segment elevation on an electrocardiogram (EKG) typically suggests acute coronary syndrome.
- However, other conditions like pericarditis and vasospasm can also cause ST-segment elevation.
- Severe hypercalcemia is a rare but critical differential diagnosis for these EKG changes.
Observation:
- An 81-year-old female with advanced lung cancer presented with fatigue, chest pain, and shortness of breath.
- Her EKG showed diffuse ST-segment elevation.
- Laboratory results revealed severe hypercalcemia (20.4 mg/dL) and elevated parathyroid hormone-related protein (PTHrP).
Findings:
- Troponin levels were normal, ruling out acute myocardial infarction.
- EKG changes resolved as the patient's calcium levels normalized during hospitalization.
- This correlation underscores the direct impact of hypercalcemia on cardiac electrical activity.
Implications:
- Hypercalcemia should be considered in the differential diagnosis of ST-segment elevation when acute coronary syndrome is absent.
- Recognizing EKG changes associated with hypercalcemia is crucial for timely diagnosis and treatment.
- This case emphasizes the interdisciplinary approach needed for complex oncologic emergencies.
Abstract:
ST-segment elevation in absence of acute coronary syndrome can be seen in multiple conditions, including acute pericarditis and coronary vasospasm, but it is rarely seen with severe hypercalcemia. The authors present a case of an 81-year-old female with a history of stage 4 squamous cell cancer of the lung, who presented to the emergency room with profound fatigue, weakness, anorexia, and drowsiness two weeks after her first chemotherapy cycle. Additionally, she had complaints of right-sided chest pain associated with worsening shortness of breath, as well as right arm numbness. An EKG obtained on arrival to the hospital showed diffuse ST-segment elevation (leads V3-V6, I, II, III, and aVF). Basic lab work found a calcium level of 20.4 mg/dl with elevated parathyroid hormone-related protein (PTHrP) of 135 pg/ml. Troponin I remained within normal limits. Serial EKS obtained during the patient's hospitalization demonstrated resolution of the ST elevation as calcium level normalized. This case emphasizes the importance of hypercalcemia as a differential diagnosis for ST-segment elevation and QT shortening when acute coronary syndrome is not present. Awareness of these EKG changes is critical for early diagnosis, recognition, and appropriate treatment.
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