Hypophosphatemia causing ST elevation in a critically ill noncardiac surgery postoperative patient

Area of Science:

• Cardiology
• Critical Care Medicine
• Nephrology

Background:

• A 73-year-old female with peripheral vascular disease, coronary artery disease, and systemic lupus erythematosus underwent mesenteric artery bypass surgery.
• Post-operatively, the patient developed pneumonia, leading to acute hypoxic respiratory failure and septic shock.

Observation:

• Septic shock resulted in acute renal failure, necessitating intubation, mechanical ventilation, and continuous veno-venous hemodialysis.
• Telemetry monitoring revealed ST elevation, confirmed by electrocardiogram, with anterior ST elevation and inferior reciprocal ST depression.

Findings:

• The electrocardiogram findings, including marked ST elevation in anterior leads and reciprocal ST depression, alongside a prolonged QT interval, are highly suggestive of acute myocardial infarction.
• The patient's complex medical history and post-operative complications created a high-risk scenario for cardiac events.

Implications:

• This case underscores the importance of considering acute myocardial infarction in critically ill patients presenting with new-onset ST elevation, even amidst other severe complications.
• Prompt diagnosis and management of ST elevation myocardial infarction are critical for improving survival rates in high-risk surgical patients.