Peerbhai Shareez, Masha Luke, DaSilva-DeAbreu Adrian, Dhoble Abhijeet
Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, 77030, TX, USA.
Department of Internal Medicine, Section of Cardiology, The University of Texas Health Science Center at Houston, Houston, USA.
Int J Emerg Med. 2017 Dec;10(1):3. doi: 10.1186/s12245-017-0132-0. Epub 2017 Jan 26.
Hyperkalemia is a common electrolyte abnormality and has well-recognized early electrocardiographic manifestations including PR prolongation and symmetric T wave peaking. With severe increase in serum potassium, dysrhythmias and atrioventricular and bundle branch blocks can be seen on electrocardiogram. Although cardiac arrest is a worrisome consequence of untreated hyperkalemia, rarely does hyperkalemia electrocardiographically manifest as acute ischemia.
We present a case of acute renal failure complicated by malignant hyperkalemia and eventual ventricular fibrillation cardiac arrest. Recognition of this disorder was delayed secondary to an initial ECG pattern suggesting an acute ST segment elevation myocardial infarction (STEMI). Emergent coronary angiography performed showed no evidence of coronary artery disease.
Pseudo-STEMI patterns are rarely seen in association with acute hyperkalemia and are most commonly described with patient without acute cardiac symptomatology. This is the first such case presenting concurrently with cardiac arrest. A brief review of this rare pseudo-infarct pattern is also given.
高钾血症是一种常见的电解质异常，具有公认的早期心电图表现，包括PR间期延长和T波对称高尖。随着血清钾严重升高，心电图上可见心律失常以及房室和束支传导阻滞。虽然心脏骤停是未治疗的高钾血症令人担忧的后果，但高钾血症很少在心电图上表现为急性缺血。
我们报告一例急性肾衰竭合并恶性高钾血症并最终发生心室颤动心脏骤停的病例。由于最初的心电图模式提示急性ST段抬高型心肌梗死（STEMI），对该疾病的识别被延迟。急诊冠状动脉造影显示没有冠状动脉疾病的证据。
假性STEMI模式很少与急性高钾血症相关，最常见于无急性心脏症状的患者。这是首例同时出现心脏骤停的此类病例。本文还对这种罕见的假性梗死模式进行了简要综述。
