Severe hypocalcemia mimicking acute inferior ST-segment elevation myocardial infarction

Adeel, Muhammad; Clarke, John‐Ross D.; Shetty, Safal; Arora, Ashish; Buscher, Michael

doi:10.1093/omcr/omy103

Cited by 14 publications

(21 citation statements)

References 24 publications

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“…Speci c regional patterns, like the inferior pattern seen in our patient, are rare (text box 2). Regional pericarditis 14 Severe hypocalcaemia 15 Acute pancreatitis 16 Pulmonary embolus 17…”

Section: Discussionmentioning

confidence: 99%

The Way to a Man’s Heart Is Through His Stomach: a Case of Myocardial Infarction Mimic and Pseudo-tamponade in a Polytrauma Patient.

Brun

Pearson

et al. 2021

Preprint

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Background: There exists a therapeutic conflict between haemorrhage control and prevention of thromboembolic events following polytrauma and complications are not uncommon. Such opposing therapies can result in unexpected pathophysiology and there is a real risk of misdiagnosis resulting in harm. This case presents a previously unreported complication of prevention and management of thromboembolism- STEMI (ST elevation myocardial infarction) and tamponade mimic secondary to retroperitoneal haematoma.Case presentation: We present a 50-year-old male polytrauma patient who following treatment for presumed pulmonary embolus demonstrated classical clinical findings of myocardial infarction and pericardial tamponade secondary to a retroperitoneal haematoma. This is an event not previously reported in the literature. The risk of adverse outcome by management along the standard lines of STEMI (ST elevation myocardial infarction) was averted through awareness for alternative aetiology via a multi-team approach which resulted in percutaneous drainage of the haematoma and complete resolution of symptoms.Conclusions: This manuscript highlights the therapeutic conflict between haemorrhage control and prevention of thromboembolic events in critically injured, the importance of high index of suspicion in this patient cohort and the benefits of multidisciplinary decision making in the complex patient through a not previously published pathophysiologic phenomenon.

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Section: Discussionmentioning

confidence: 99%

The Way to a Man’s Heart Is Through His Stomach: a Case of Myocardial Infarction Mimic and Pseudo-tamponade in a Polytrauma Patient.

Brun

Pearson

et al. 2021

Preprint

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“…The most commonly described ECG change of hypercalcemia is a shortened QTc interval due to rapid repolarization. However, severely elevated calcium levels have been reported to mimic ST-elevation on the ECG [8,9]. Some other ECG changes expected may include abrupt upslope of T wave, PR interval prolongation, and increase the amplitude of the QRS complex.…”

Section: Discussionmentioning

confidence: 99%

Rare ST-Elevation Myocardial Infarction Mimic: Diabetic Ketoacidosis With Severe Hypercalcemia

Ahmed

Haque

2020

Cureus

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Diabetic ketoacidosis (DKA) is a common complication in patients with type I and ketosisprone type II diabetes mellitus. A variety of electrolyte derangements are encountered during the presentation and management of DKA. Hypercalcemia has been rarely reported in DKA, particularly when patients develop severe acidosis. However, we describe a patient with DKA and severe hypercalcemia in the absence of severe acidosis. The hypercalcemia quickly corrected back to normal with the treatment of DKA.

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“…[3][4][5] Acute hypocalcaemia is a rare cause of coronary artery spasm, and even more so when triggered by CKD and pancreatitis. [3][4][5][6] The concept of hypocalcaemia-induced coronary artery vasospasm syndrome is contentious, as it seems unlikely that a single artery would undergo sufficient vasospasm to cause ischaemia, without another artery of SHORT REPORT similar calibre causing ischaemic symptoms at a distant site. The counter-argument to this is that the cardiac blood supply is unique, with the majority of the myocardium being perfused during diastole.…”

Section: Discussionmentioning

confidence: 99%

An unexpected acute coronary syndrome

Hougenhouck-Tulleken¹,

Ueckermann²

2019

S Afr J Crit Care

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Contribution of study• Hypocalcaemia is a common clinical problem that is usually clinically quiescent, but in the acute setting can present with dramatic signs and symptoms. • Hypocalcaemia resulting in an acute coronary syndrome is usually rapidly reversed by administering intravenous calcium. • A hypocalcaemia-induced acute coronary syndrome is most likely a function of the myocardium being perfused primarily during diastole, with partial vasospasm limiting the diastolic flow during times of increased cardiac output or energy requirements.Acute coronary syndromes due to coronary artery vasospasm occur rarely and are difficult to diagnose in the acute setting. We present a patient with hypocalcaemia-induced coronary artery vasospasm, which resulted in an acute ST-elevation myocardial infarction. This was reversible upon administering intravenous calcium, with no long-term cardiac consequences for our patient.

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Severe hypocalcemia mimicking acute inferior ST-segment elevation myocardial infarction

Cited by 14 publications

References 24 publications

The Way to a Man’s Heart Is Through His Stomach: a Case of Myocardial Infarction Mimic and Pseudo-tamponade in a Polytrauma Patient.

The Way to a Man’s Heart Is Through His Stomach: a Case of Myocardial Infarction Mimic and Pseudo-tamponade in a Polytrauma Patient.

Rare ST-Elevation Myocardial Infarction Mimic: Diabetic Ketoacidosis With Severe Hypercalcemia

An unexpected acute coronary syndrome

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