Double counting heart rate - Littmann sign in electrocardiogram
Wei Wang1, Mei-Yu Deng2, Wen-Hui Zhai1
1From the Emergency Department, 305 Hospital of PLA, Beijing (100017), People's Republic of China.
Insights
The Littmann sign, though uncommon, is crucial for rapidly diagnosing hyperkalemia. Prompt identification aids timely treatment and patient recovery, preventing potential complications from delayed intervention.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Diagnosis
Background:
- The Littmann sign is an infrequently observed clinical finding.
- It is often overlooked in routine practice, potentially delaying critical diagnoses.
- Hyperkalemia, a condition of elevated potassium levels, requires prompt management.
Observation:
- A 68-year-old patient presented with discrepancies between electrocardiogram (ECG) heart rate and cardiac auscultation.
- This inconsistency, suggestive of the Littmann sign, raised suspicion for hyperkalemia.
- Arterial blood gas analysis confirmed significant hyperkalemia.
Findings:
- The Littmann sign served as an early indicator for hyperkalemia in this case.
- Prompt initiation of potassium-lowering treatment led to the resolution of the Littmann sign.
- The patient experienced a full recovery after successful management of hyperkalemia.
Implications:
- Emphasizes the importance of recognizing the Littmann sign for early hyperkalemia detection.
- Highlights the potential for overlooked signs to cause diagnostic delays.
- Underscores the necessity of integrating subtle clinical findings into diagnostic algorithms for metabolic emergencies.
Abstract:
This report highlights necessity of correctly and quickly identifying Littmann sign. Littmann sign is not common in clinical practice, which is easily overlooked by most physicians, leading to delays in the treatment of hyperkalemia. A 68 year old patient with hyperkalemia was found to have inconsistent heart rate displayed on electrocardiogram monitoring with cardiac auscultation and synchronous electrocardiogram in the early stages of onset. Hyperkalemia was highly suspected by the Littmann sign. After completing arterial blood gas analysis, hyperkalemia was identified and active potassium lowering treatment was immediately initiated. The Littmann syndrome disappeared, and the patient eventually recovered.
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