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An advanced degree of body potassium deficit may produce striking changes in the electrocardiogram (ECG). These changes can result in incidental findings on the 12-lead ECG or precipitate potentially life-threatening dysrhythmias. Although usually readily recognized, at times these abnormalities may be confused with myocardial ischemia. The object was to report a case of severe hypokalemia mimicking myocardial ischemia. A 33-year-old, previously healthy man, presented to the Emergency Department (ED) with a progressive weakness and chest discomfort. The electrocardiogram showed a marked ST-segment depression in leads II, III, aVF, V1-V6. The initial diagnosis was non ST-elevation myocardial infarction. Echocardiography was normal and troponin levels were within normal limits. A more detailed history revealed that the patient had an episode of acute gastroenteritis with diarrhea and vomiting. Serum chemistries were notable for a potassium concentration of 1,8 mmol per liter. With aggressive electrolyte correction, the ECG abnormalities reverted as potassium levels normalized. Hypokalemia induced ST-segment depression may simulate myocardial ischemia. The differential diagnosis might be difficult, especially in the cases when ST changes are accompanied with chest discomfort.

A 62-year old man with chronic renal insufficiency reported having reduced exercise tolerance for the previous week. The physical examination was unremarkable, but oxygen saturation was diminished. An electrocardiogram showed a regular rhythm, with a widened QRS complex in a sine-wave configuration, and there were no discernible P waves. The T waves were fused with the widened QRS complexes (Panel A) to form the sine-wave pattern, raising suspicion of severe hyperkalemia. The patient's serum potassium level was 9.1 mmol per liter. His condition stabilized after the administration of calcium chloride, bicarbonate, glucose, and insulin therapy, which was followed by hemodialysis. Serial electrocardiograms showed progressive narrowing of the QRS complex. At 24 hours after presentation, electrocardiography revealed a left bundle-branch pattern (Panel B), and his condition remained stable. Hyperkalemia triggers a progression of electrocardiographic changes, beginning with peaked T waves and PR prolongation. More severe elevations in potassium level can result in QRS widening and loss of P waves, with eventual formation of the sine-wave pattern seen here. The rhythm can degenerate into ventricular fibrillation if the cardiac membrane is not stabilized.

recanalization score in 20 min post treatment and often failed to recanalize the CCA. Histomorphometry and luminal SEM evaluation revealed that the operation of the infusion device is comparable to balloon angioplasty with endothelial cell denudation and an exposure of the internal elastic lamina, an acceptable level of disruption for mechanical revascularization devices. Conclusion Combined pharmaco-mechanical disruption achieves a high recanalization grade with a lower thombolytic dose more rapidly in comparison to either therapy (balloon angioplasty and thrombolysis) used alone. IntroductionThe influence of meteorological variables on the incidence of ischemic stroke has been described in neurological literature. The link between weather conditions and overall morbidity and mortality has been established, with an increase during the winter months and during periods of extreme heat. Conversely, certain studies have established a link between lower temperatures and ischemic events. The equivocal data demands further inquiry into the connection between weather variable and ischemic events. Since certain studies on the association of stroke and meteorological variable are based in areas of very specific, extreme weather patterns the results may not be generalizable to more temperate climates. We aim to investigate the role of meteorological variables on the rate of ischemic events in a representative east coast inner city population. Methods A database of stroke patients treated at University Hospital in Newark, NJ, from 7.2009 to 7.2010 was used. Standardized data collection were utilized, including demographic, relevant medical history, medications, laboratory data on admission, vitals on admission, and disease course. Consecutive days with stroke admissions as well as singleton days with multiple stroke admissions were classified as clusters. Data from the national weather database data from the event dates recorded at the Newark airport weather station located 5.4 miles from University Hospital as well as the weather underground database (wunderground.com), collected 1.1 miles away from University Hospital was compared on ischemic event vs no ischemic event days as well as cluster vs noncluster days. Data were analyzed using ANOVA to compare weather parameter as follows: (1) dates with ischemic events to days without ischemic event;(2) cluster vs non-cluster days. Results During the study period, 297 ischemic events were treated at University Hospital, 267 with ischemic stroke and 30 with TIA. The variation of monthly admission rates was insignificant. Analysis of the data revealed a statistically significant correlation between a decrease in max temperature, min temperature, average temp, dew point, and wet bulb temperature and an increased incidence of stroke. Likewise, a statistically significant decrease in those variables was also associated with increased clustering of ischemic events (p<0.01). Conclusion Lower temperatures as well decrease in relative humidity (measured by wet bulb temperature and dew p...

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