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Electrocardiographic changes simulating acute myocardial infarction caused by hyperkalemia: report of a patient with
Insights
Severe diabetic ketoacidosis and hyperkalemia can mimic heart attack on ECG. Prompt treatment of high potassium levels normalized ECG findings, ruling out coronary artery disease in this unique case.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes, often associated with electrolyte disturbances.
- Hyperkalemia, a common finding in DKA, can significantly impact cardiac electrical activity.
Observation:
- A patient presented with severe DKA and hyperkalemia, exhibiting electrocardiogram (ECG) changes suggestive of acute anterior wall myocardial infarction.
- The patient's ECG abnormalities resolved rapidly following treatment for hyperkalemia.
Findings:
- Extensive cardiac work-up, including exercise testing and coronary arteriography, excluded significant coronary artery disease.
- The ECG manifestations were attributed to hyperkalemia, not ischemic heart disease.
Implications:
- This case highlights the critical importance of recognizing hyperkalemia as a potential mimic of myocardial infarction on ECG.
- It underscores the need for prompt electrolyte management in patients with DKA presenting with cardiac symptoms.
- This represents a rare instance where ECG changes mimicking infarction were definitively attributed to hyperkalemia after comprehensive cardiac evaluation.
Abstract:
A patient is described with severe diabetic ketoacidosis and hyperkalemia who presented with an ECG resembling an acute anterior wall myocardial infarction. Treatment of hyperkalemia resulted in prompt return of the ECG towards normal. Subsequent work-up including exercise testing and selective coronary arteriography ruled out any significant coronary artery disease suggesting that the ECG changes were probably caused by hyperkalemia. While similar changes have rarely been described in the past, this would appear to be the first such case in whom coronary artery disease was ruled out by a negative exercise testing and coronary arteriography.