High Frequency of Early Repolarization and Brugada-Type Electrocardiograms in Hypercalcemia

Sonoda, Koji; Watanabe, Hiroshi; Hisamatsu, Takashi; Ashihara, Takashi; Ohno, Seiko; Hayashi, Hideki; Horie, Minoru; Minamino, Tohru

doi:10.1111/anec.12303

Cited by 19 publications

(12 citation statements)

References 32 publications

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“…In a study conducted by Sonoda et al, 89 patients with hypercalcemia were analyzed. Elevated J point was seen in 30% of the total; however, no fatal arrhythmia was observed during the study period [9]. Conversely, in few case reports, hypercalcemia and a Brugada-type pattern had resulted in ventricular fibrillation [14].…”

Section: Discussionmentioning

confidence: 87%

“…EKG of a hypercalcemic patient may also demonstrate prolongation of the PR and QRS intervals, increased amplitude of the QRS complex, Osborn (J) waves, J point elevation (including early repolarization and Brugada-type EKG), biphasic inverted or notched T waves, and prominent U waves [8,9]. In a large case series performed by Littman et al, a total of 16 cases of severe hypercalcemia with concomitant ST-segment elevation on EKGs mimicking acute coronary syndrome were described.…”

Section: Discussionmentioning

confidence: 99%

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Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature

Abugroun

Tyle

Faizan

et al. 2020

Case Reports in Emergency Medicine

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ST-segment elevation in absence of acute coronary syndrome can be seen in multiple conditions, including acute pericarditis and coronary vasospasm, but it is rarely seen with severe hypercalcemia. e authors present a case of an 81-year-old female with a history of stage 4 squamous cell cancer of the lung, who presented to the emergency room with profound fatigue, weakness, anorexia, and drowsiness two weeks after her first chemotherapy cycle. Additionally, she had complaints of right-sided chest pain associated with worsening shortness of breath, as well as right arm numbness. An EKG obtained on arrival to the hospital showed diffuse ST-segment elevation (leads V3-V6, I, II, III, and aVF). Basic lab work found a calcium level of 20.4 mg/dl with elevated parathyroid hormone-related protein (PTHrP) of 135 pg/ml. Troponin I remained within normal limits. Serial EKS obtained during the patient's hospitalization demonstrated resolution of the ST elevation as calcium level normalized. is case emphasizes the importance of hypercalcemia as a differential diagnosis for ST-segment elevation and QT shortening when acute coronary syndrome is not present. Awareness of these EKG changes is critical for early diagnosis, recognition, and appropriate treatment.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature

Abugroun

Tyle

Faizan

et al. 2020

Case Reports in Emergency Medicine

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“…In a study by Sonoda et al, patients with hypercalcemia was found to induce J point elevation, which is common in Brugada-type ECG patterns and early repolarization. This may be explained by transmural differences in the magnitude to the AP notch and a decreased inward Na þ -Ca 2þ exchanger current [98]. Following the resolution of hypercalcemia, the frequency of J point elevation decreased, and arrhythmias only rarely occurred in these patients suggesting that hypercalcemia might have some proarrhythmic effects [98].…”

Section: External Influences That Trigger Brugadamentioning

confidence: 99%

Brugada syndrome

Korlipara¹,

Korlipara

Pentyala³

2020

Acta Cardiologica

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Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome that causes a heightened risk for ventricular tachyarrhythmias and sudden cardiac death. BrS is characterised by a coved ST-segment elevation in right precordial leads. The prevalence is estimated to range between 1 in 5,000 to 1 in 2,000 in different populations, with the highest being in Southeast Asia and in males. More than 18 genes associated with BrS have been discovered and recent evidence has suggested a complex polygenic mode of inheritance with multiple common and rare genetic variants acting in concert to produce the BrS phenotype. Diagnosis of BrS in patients currently relies on presentation with a type-1 Brugada pattern on ECG either spontaneously or following a drug provocation test using a sodium channel blocker. Risk assessment in patients diagnosed with BrS is controversial, especially with regard to the predictive value of programmed electrical stimulation and novel ECG parameters, such as QRS fragmentation. The first line of BrS therapy remains an implantable cardioverter defibrillator (ICD), although radiofrequency catheter ablation has been shown to be an effective option in patients with contraindications for an ICD. True BrS can be unmasked on ECG in susceptible individuals by monitoring factors such as fever, and this has been recently evident in several patients infected with the 2019 novel coronavirus (COVID-19). Aggressive antipyretic therapy and regular ECG monitoring until fever resolves are current recommendations to help reduce the arrhythmic risk in these COVID-19 patients. In this review, we summarise the current knowledge on the epidemiology, pathophysiology, genetics, clinical diagnosis, risk stratification and treatment of patients with BrS, with special emphasis on COVID-19 comorbidity.

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“…1 In this issue of Annals of Noninvasive Electrocardiology, Sonoda et al 2 analyzed the effects of hypercalcemia on the ECG, focusing on its effects on J point elevation and arrhythmias. Not surprisingly, abnormal serum electrolyte levels alter cardiac ion current kinetics.…”

mentioning

confidence: 99%

“…In some cases, timely diagnosis of electrolyte abnormalities is crucial and emergency therapy for presumed life-threatening electrolyte disorders are often initiated, based on diagnostic ECG changes, even before laboratory results become available. 1 In this issue of Annals of Noninvasive Electrocardiology, Sonoda et al 2 analyzed the effects of hypercalcemia on the ECG, focusing on its effects on J point elevation and arrhythmias. They compared the ECG of 89 patients with hypercalcemia (serum Ca level, corrected for serum albumin, >12 mg/dL) with those of 267 age-and sex-matched healthy controls.…”

mentioning

confidence: 99%