Hypercalcemia Due to Rhabdomyolysis Mimicking Brugada Syndrome

Abstract

We describe a 62-year-old man with a history of multiple myeloma and prostate cancer, presenting with rhabdomyolysis (from a prolonged fall at home), serum calcium 14 mg/dL, and electrocarAddress for reprints: Figure 1. Electrocardiograms at serum calcium levels of: A) 14.0 mg/dl, B) 9.7 mg/dl, and C) 8.8 mg/dl. diogram (ECG) showing coved ST segment elevations in leads V1-V3 typical of Type 1 Brugada syndrome. Hypercalcemia has been reported as a cause of ST elevation mimicking Brugada syndrome. 1-3 There was no family history of sudden death. Potassium was 4.4 meq/L. Echocardiogram showed normal ventricular function. Minimal troponin-I elevation (0.2 mg/dL) was attributed to massive creatine kinase elevation from rhabdomyolysis. ECG changes resolved with hypercalcemia correction (Figure 1). On repeat visits, the patient had unremarkable ECGs. References 1. Littmann L, Taylor L, Brearley, W. ST-segment elevation: A common finding in severe hypercalcemia.

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

“…[7][8][9] Hypercalcemia was associated with QT interval shortening and delayed cardiac conduction; these ECG changes were restored when serum Ca 2+ levels returned to the normal range. Brugada-type ECG findings have been reported in the right precordial leads in the setting of hypercalcemia, in two case reports, 13,14 and were found in 6% of patients with hypercalcemia in this study. The frequency of J point elevation was not different among causes of hypercalcemia.…”

“…18 In this study, 6% of patients with hypercalcemia exhibited the scooped appearance. Brugada-type ECG findings have been reported in the right precordial leads in the setting of hypercalcemia, in two case reports, 13,14 and were found in 6% of patients with hypercalcemia in this study. Furthermore, this study demonstrated that hypercalcemia was also associated with early repolarization, as was the case in previous case reports.…”

“…2,22 Furthermore, ventricular tachyarrhythmias have occasionally been reported in patients with hyperparathyroidism who have J point elevation in the setting of hypercalcemia. 7,[10][11][12][13][14][15][16][17][18]23 However, although J point elevation was frequently found in patients with hypercalcemia due to various diseases, no fatal arrhythmia was observed during short periods of hospitalization in this study. The number of patients and observation periods in this study may not be enough to observe the association of J point elevation with the risk of arrhythmia.…”

Brugada Phenocopy: New Terminology and Proposed Classification

“…Thirty‐one cases were identified as meeting our inclusion criteria 72–102 . To confirm these cases as manifestations of Brugada phenocopies, we first sought to assess the clinical probability that the patients had true Brugada syndrome.…”

“…Fourteen cases were included in the metabolic condition category. 72–85 Thirteen patients showed Brugada Type‐1 ECG and five showed Type‐2 ECG. Four of the patients’ ECG switched between a Brugada Type‐1 and a Type‐2 ECG pattern (i.e., had both).…”