Lesson of the week: Misleading electrocardiographic results in patient with hyperkalaemia and diabetic ketoacidosis

Moulik, Probal; Nethaji, C; Khaleeli, A. A.

doi:10.1136/bmj.325.7376.1346

Cited by 26 publications

(10 citation statements)

References 6 publications

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“…Significant and dramatic changes in the EKG may be seen with even small changes in potassium concentration (1). Review of 24 cases in the literature of pseudomyocardial infarction due to hyperkalemia revealed that an anterior-septal pseudo-infarct pattern is most common (19 cases; 79.2%) (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Three cases (12.5%) involved both anterior-septal and inferior distribution (18,19).…”

Section: Discussionmentioning

confidence: 95%

Pseudo-Myocardial Infarction in Diabetic Ketoacidosis with Hyperkalemia

Bellazzini

Meyer

2010

The Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 95%

Pseudo-Myocardial Infarction in Diabetic Ketoacidosis with Hyperkalemia

Bellazzini

Meyer

2010

The Journal of Emergency Medicine

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“…interpreting this data as a whole is limited given incomplete reporting of data in prior cases. Many of these reports theorize that the resolution of these ECG findings correlated with significant corrections in patient potassium levels [3,[6][7][8][10][11]. This specific case demonstrated normalization of the patient's ECG with clinically insignificant improvement in serum potassium levels.…”

Section: Figure 1: Initial Electrocardiogram Obtained Upon Arrival Tomentioning

confidence: 78%

ST-Segment Elevation in the Setting of Diabetic Ketoacidosis: Is It Acute Coronary Syndrome?

Wray

Yoo

Bridwell

et al. 2020

Cureus

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Diabetic ketoacidosis (DKA) with resulting hyperkalemia can lead to ST-segment elevations on electrocardiogram (ECG). Previous publications theorize that significant improvements in patient potassium levels lead to the resolution of this rare phenomenon, also known as "pseudo-infarct" pattern. The authors provide a unique case along with a literature review of DKA-associated ST-segment elevations. This specific case distinctively demonstrates the resolution of the pseudo-infarct pattern in the setting of minor improvements in serum potassium and continued acidosis.

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“…ST-segment elevation in diabetic ketoacidosis may suggest acute myocardial infarction. In the available literature there are a few reports of ST-segment elevation in patients with DKA, in whom acute coronary syndrome was ruled out on the basis of the performed cardiac diagnostics [3][4][5][6][7][8][9][10]. Hyperkalaemia was suggested as the cause of ST-segment elevation, as it changes the conduction of electrical impulses in the myocardium and the timing of the depolarisation period [3].…”

Section: Discussionmentioning

confidence: 99%

“…ST-segment elevation in the course of DKA is extremely rare. There are only a few such reports in the available literature andthey mainly involved patients with hyperkalaemia [3][4][5][6][7][8][9]. In this article we present a patient with DKA, severe retrosternal pain and normokalaemia, in whom ST-segment elevation in the ECG was observed, imitating acute myocardial infarction.…”

Section: Introductionmentioning

confidence: 96%

Clinical and ECG patterns of pseudoinfarction in a young man with type 1 diabetes, diabetic ketoacidosis and normokalaemia

Fronczyk

Molęda

Majkowska

2016

Clinical Diabetology

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Diabetic ketoacidosis (DKA) can cause changes in the electrocardiogram (ECG) in the form of transient ST-segment depression, QT prolongation, changes in T-wave morphology and the appearance of U wave, possibly due to changes in the serum potassium level. Occasional reports indicate the possibility of transient ST-segment elevation imitating myocardial infarction in the course of hyperkalaemia accompanying DKA. In this article we present a case of a 20-year-old male patient with type 1 diabetes mellitus, DKA and normokalaemia, who experienced severe retrosternal pain, and ECG presented ST-segment elevation imitating acute myocardial infarction of the anterior wall. On the basis of the performed cardiac tests, including laboratory testing, coronary angiography and ultrasound scan, acute coronary syndrome was ruled out. The regression of retrosternal pain and electrocardiographic changes with patient hydration and correction of metabolic disorders suggest the diagnosis of pseudopericarditis, i.e. non-infections irritation of the pericardial membranes due to the loss of fluid in the pericardial sac as a result of dehydration. The diagnosis of acute myocardial infarction based on ST-segment elevation in the ECG recording in a patient with diabetes mellitus and ketoacidosis, without concomitant hyperkalaemia, must be made very carefully, even in the presence of retrosternal pain. The possibility of pseudopericarditis associated with severe dehydration must also be considered.

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Lesson of the week: Misleading electrocardiographic results in patient with hyperkalaemia and diabetic ketoacidosis

Cited by 26 publications

References 6 publications

Pseudo-Myocardial Infarction in Diabetic Ketoacidosis with Hyperkalemia

Pseudo-Myocardial Infarction in Diabetic Ketoacidosis with Hyperkalemia

ST-Segment Elevation in the Setting of Diabetic Ketoacidosis: Is It Acute Coronary Syndrome?

Clinical and ECG patterns of pseudoinfarction in a young man with type 1 diabetes, diabetic ketoacidosis and normokalaemia

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