A Mimic of Myocardial Ischemia in a Woman With Hyperemesis Gravidarum

Abstract

A woman in her 20s who was 12 weeks pregnant presented to the emergency department with a 2-day history of severe chest pain and palpitations. She had been experiencing nausea and vomiting during the past 5 weeks, which had worsened in the preceding 4 days. On examination, the patient's blood pressure was 111/83 mm Hg, oxygen saturation was 96% on room air, and heart rate was 140 beats per minute, which settled to 90 beats per minute with intravenous fluids. She had dry mucous membranes, but the results of a cardiopulmonary examination were otherwise normal. Results of the electrocardiogram (ECG) at admission showed widespread ST segment depression with ST elevation in lead aVR (Figure , A).Question: What is the likely cause of these ECG findings in this young pregnant woman?