Transient complete atrioventricular block and ST-segment elevation induced by coronary vasospasm due to iatrogenic
Miaomiao Cao1, Li Chen1, Chaofeng Sun2
1Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
Insights
Severe hyperkalemia can trigger acute coronary syndrome and complete atrioventricular block. Prompt coronary angiography is crucial for diagnosing the cause of atrioventricular block in such cases.
Area of Science:
- Cardiology
- Internal Medicine
- Electrophysiology
Background:
- Hyperkalemia and acute coronary syndrome (ACS) share electrocardiogram (ECG) manifestations and can both cause syncope due to complete atrioventricular block (AVB).
- These conditions are known to influence each other, complicating diagnosis and management.
Observation:
- A 32-year-old man presented with severe hypokalemia, which unexpectedly rebounded to severe hyperkalemia (7.76 mmol/l) after potassium repletion therapy.
- Following hyperkalemia, the patient developed chest discomfort, dyspnea, and syncope, accompanied by ECG findings of complete AVB and ST elevation.
Findings:
- The patient was diagnosed with transient complete AVB induced by coronary vasospasm secondary to iatrogenic hyperkalemia, despite mild coronary stenosis and negative cardiac markers.
- Hypokalemic periodic paralysis was also considered given normal urine potassium excretion and acid-base status.
Implications:
- This case highlights that hyperkalemia can precipitate acute coronary syndrome, presenting as AVB.
- Early coronary angiography is an effective diagnostic tool for identifying the direct cause of acute complete AVB in the context of hyperkalemia.
Background:
Hyperkalemia and acute coronary syndrome are not only all responsible for syncope related to complete atrioventricular block, but also share parts of electrocardiogram manifestations. Additionally, they influence each other.
Case Presentation:
A 32-year-old Chinese man presented with severe hypokalemia (1.63 mmol/l) at midnight in the emergency room. He developed unexpected rebound hyperkalemia (7.76 mmol/l) after 18 hours of oral and intravenous potassium chloride supplementation at a concentration of about 10 g/day and a rate of 10 mmol/hour. Subsequently, the patient complained of chest discomfort and dyspnea, followed by syncope for several minutes, approximately 2 hours after potassium reduction treatment had been started. The instant electrocardiogram showed complete atrioventricular block and elevated ST segment in the inferolateral leads, which resolved 15 minutes later, before hyperkalemia was corrected. Combined with mild coronary stenosis and negative myocardial injury markers, transient complete atrioventricular block induced by coronary vasospasm due to iatrogenic hyperkalemia was diagnosed. Normal urine potassium excretion, acid-base state, and other examinations made the diagnosis of hypokalemic periodic paralysis possible.
Conclusions:
Hyperkalemia may provoke acute coronary syndrome, and early coronary angiography is an effective strategy for identifying the direct cause of acute complete atrioventricular block.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:12Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers