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[The electrocardiographic image of acute myocardial infarct in a patient with severe hyperkalemia]
S Polić1, Z Rumboldt, J Bagatin
1Interna klinika Klinickog bolnickog centra u Splitu i Medicinskog fakulteta Sveucilista u Zagrebu.
Insights
This study highlights a diabetic patient with kidney issues whose ECG mimicked a heart attack due to severe hyperkalemia. Advanced hyperkalemia, not myocardial infarction, should be suspected with specific ECG changes.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Insulin-dependent diabetes mellitus and chronic renal insufficiency are common comorbidities.
- Patients on hemodialysis are at risk for electrolyte imbalances.
- Alimentary intoxication can precipitate acute metabolic disturbances.
Abstract:
We report herein an insulin dependent diabetic with chronic renal insufficiency on hemodialysis who developed cardiogenic shock, severe metabolic acidosis with kalemia of 9 mmol/L during alimentary intoxication and who presented with an ECG resembling an acute myocardial infarction. Possible pathophysiologic factors in the development of such electrocardiographic patterns have been outlined. It is concluded that in far advanced hyperkalemia an abnormal QRS complex, elevated ST segment and no visible P waves should primarily suggest changes caused by hyperkalemia rather than myocardial infarction.