Pseudoinfarction pattern in a patient with hyperkalemia, diabetic ketoacidosis and normal coronary vessels: a case report

Abstract

IntroductionA rare electrocardiographic finding of hyperkalemia is ST segment elevation or the so called 'pseudoinfarction' pattern. It has been suggested that hyperkalemia causes the 'pseudoinfarction' pattern not only through its direct myocardial effects, but also through other mechanisms, such as anoxia, acidosis, and coronary artery spasm.Case presentationA 33-year-old Caucasian woman with insulin-treated diabetes presented with continuous epigastric pain of four hours duration. Her coronary heart disease risk factors apart from diabetes included hypercholesterolemia and smoking. Her initial electrocardiogram revealed ST segment elevation in the anteroseptal leads consistent with anterior myocardial infarction. Blood tests revealed hyperglycemia, hyperkalemia, metabolic acidosis and urine ketones, while a bed-side cardiac echocardiogram showed no segmental wall motion abnormality. We provisionally diagnosed diabetic ketoacidosis that was possibly precipitated by acute myocardial infarction, as there were findings in favor of (epigastric pain, electrocardiogram pattern, presence of 3 coronary heart disease risk factors) and against (young age, normal echocardiogram) the diagnosis of acute myocardial infarction. We performed cardiac angiography in order to exclude an anterior acute myocardial infarction, which could lead to myocardial damage and possible severe complications should there be a delay in treatment. Angiography revealed normal coronary arteries. During the procedure, ST segment elevation in the anteroseptal leads was still present in our patient's electrocardiogram results.ConclusionST segment elevation is a rare manifestation of hyperkalemia. In our patient, coronary spasm did not contribute to such an electrocardiography finding.

Electrocardiographic findings in 130 hospitalized neonatal calves with diarrhea and associated potassium balance disorders

“…ST segment elevation was also described as a rare manifestation of hyperkalemia in humans (most frequently in patients with diabetic ketoacidosis) where the ECG findings can resemble acute myocardial infarction and have therefore been described as pseudoinfarct or pseudoinjury ECG pattern . The mechanisms for hyperkalemia associated ST segment elevation in humans are not well understood, but repolarization abnormalities and other concurrent metabolic abnormalities such as acidosis have been discussed …”

“…60,61 The mechanisms for hyperkalemia associated ST segment elevation in humans are not well understood, but repolarization abnormalities and other concurrent metabolic abnormalities such as acidosis have been discussed. 62 Although typical ECG abnormalities were seen in hyperkalemic calves of our study population, bradycardia, or bradyarrhythmia was a rare finding in calves with increases in cK 1 . There was also no association between heart rate and cK 1 , which is in agreement to previous clinical studies in diarrheic calves as well as dogs and cats who also found no significant relationship 63,64 or even a slight positive association.…”

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

“…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.…”

Pseudo-myocardial Infarction Pattern with Lax Esophageal hiatus with Severe Erosive Gastritis and Normal Coronary Vessels: a Case Report

“…There is increasingly documented phenomenon of pseudo-myocardial infarction that needs to be considered especially in those cases where the thrombolytic therapy has disastrous consequences. EKG changes compatible with acute myocardial infarction have been reported in association with Acute Abdomen, presenting with pancreatitis, gangrenous appendix, perforated duodenal ulcer, rectus sheath hematoma, and sepsis with shock (1) .Pseudo-myocardial infarction pattern has also been demonstrated in relation to diabetic Ketoacidosis (2) , Intracellular shift of potassium, Pulmonary embolism & Adrenergic hyper stimulation; all cases lead to picture of sick cardiomyocytes mimicking an injury current seen -Myocardial Infarction Necrosis. (3) The possible mechanism by which myocardial pseudo infarct occurs is unclear.…”