Difficulties in electrocardiographic diagnosis of hyperkalemia and acute coronary syndrome: clinical case
BACKGROUND: Clinical practice testifies to the difficulties in diagnosing hyperkalemia according to electrocardiographic (ECG) criteria during the primary contact between the doctor and the patient. This leads to the establishment of alternative diagnoses, particularly acute coronary syndrome, a del...
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| Format: | Article |
| Language: | English |
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Concilium Medicum
2023-08-01
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| Series: | КардиоСоматика |
| Subjects: | |
| Online Access: | https://cardiosomatics.ru/2221-7185/article/viewFile/430422/pdf |
| _version_ | 1797634644388085760 |
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| author | Olga A. Fomina Kristina G. Pereverzeva |
| author_facet | Olga A. Fomina Kristina G. Pereverzeva |
| author_sort | Olga A. Fomina |
| collection | DOAJ |
| description | BACKGROUND: Clinical practice testifies to the difficulties in diagnosing hyperkalemia according to electrocardiographic (ECG) criteria during the primary contact between the doctor and the patient. This leads to the establishment of alternative diagnoses, particularly acute coronary syndrome, a delay in the implementation of measures aimed at lowering the blood potassium levels and a possible adverse outcome.
CLINICAL CASE DESCRIPTION: The article presents the clinical observation of a patient with severe hyperkalemia in the background of acute renal injury caused by mesenteric thrombosis, with ECG changes in the form of high-amplitude T wave in leads V2V6 and induced non-sustained ventricular tachycardia. Considering the patients history of coronary heart disease, ECG data (high-amplitude T wave in leads V2V6) were regarded as acute coronary syndrome with ST segment elevation. According to emergency indications, the patient underwent coronary angiography and endoprosthetics of the left circumflex artery (stenosis 99%). Upon further examination, levels of biomarkers of myocardial necrosis were slightly increased, which confirmed the established preliminary diagnosis and hyperkalemia. However, 6 h after hospitalization, the patient died. A subsequent autopsy revealed a contradiction between the clinical path and anatomical diagnosis.
CONCLUSION: This case reveals the complexity of the differential diagnosis of changes in the T wave and ST segment. Failure to promptly determine the underlying cause of these ECG changes in the presented case led to an inaccurate management strategy that negatively affects the prognosis. |
| first_indexed | 2024-03-11T12:10:32Z |
| format | Article |
| id | doaj.art-3832532e550f4cc0a60c0c85a9d1f982 |
| institution | Directory Open Access Journal |
| issn | 2221-7185 2658-5707 |
| language | English |
| last_indexed | 2024-03-11T12:10:32Z |
| publishDate | 2023-08-01 |
| publisher | Concilium Medicum |
| record_format | Article |
| series | КардиоСоматика |
| spelling | doaj.art-3832532e550f4cc0a60c0c85a9d1f9822023-11-07T13:27:45ZengConcilium MedicumКардиоСоматика2221-71852658-57072023-08-0114212312910.17816/CS43042276536Difficulties in electrocardiographic diagnosis of hyperkalemia and acute coronary syndrome: clinical caseOlga A. Fomina0https://orcid.org/0000-0002-2570-7737Kristina G. Pereverzeva1https://orcid.org/0000-0001-6141-8994Pavlov Ryazan State Medical UniversityPavlov Ryazan State Medical UniversityBACKGROUND: Clinical practice testifies to the difficulties in diagnosing hyperkalemia according to electrocardiographic (ECG) criteria during the primary contact between the doctor and the patient. This leads to the establishment of alternative diagnoses, particularly acute coronary syndrome, a delay in the implementation of measures aimed at lowering the blood potassium levels and a possible adverse outcome. CLINICAL CASE DESCRIPTION: The article presents the clinical observation of a patient with severe hyperkalemia in the background of acute renal injury caused by mesenteric thrombosis, with ECG changes in the form of high-amplitude T wave in leads V2V6 and induced non-sustained ventricular tachycardia. Considering the patients history of coronary heart disease, ECG data (high-amplitude T wave in leads V2V6) were regarded as acute coronary syndrome with ST segment elevation. According to emergency indications, the patient underwent coronary angiography and endoprosthetics of the left circumflex artery (stenosis 99%). Upon further examination, levels of biomarkers of myocardial necrosis were slightly increased, which confirmed the established preliminary diagnosis and hyperkalemia. However, 6 h after hospitalization, the patient died. A subsequent autopsy revealed a contradiction between the clinical path and anatomical diagnosis. CONCLUSION: This case reveals the complexity of the differential diagnosis of changes in the T wave and ST segment. Failure to promptly determine the underlying cause of these ECG changes in the presented case led to an inaccurate management strategy that negatively affects the prognosis.https://cardiosomatics.ru/2221-7185/article/viewFile/430422/pdfhyperkalemiaacute coronary syndromemesenteric thrombosisacute renal injury |
| spellingShingle | Olga A. Fomina Kristina G. Pereverzeva Difficulties in electrocardiographic diagnosis of hyperkalemia and acute coronary syndrome: clinical case КардиоСоматика hyperkalemia acute coronary syndrome mesenteric thrombosis acute renal injury |
| title | Difficulties in electrocardiographic diagnosis of hyperkalemia and acute coronary syndrome: clinical case |
| title_full | Difficulties in electrocardiographic diagnosis of hyperkalemia and acute coronary syndrome: clinical case |
| title_fullStr | Difficulties in electrocardiographic diagnosis of hyperkalemia and acute coronary syndrome: clinical case |
| title_full_unstemmed | Difficulties in electrocardiographic diagnosis of hyperkalemia and acute coronary syndrome: clinical case |
| title_short | Difficulties in electrocardiographic diagnosis of hyperkalemia and acute coronary syndrome: clinical case |
| title_sort | difficulties in electrocardiographic diagnosis of hyperkalemia and acute coronary syndrome clinical case |
| topic | hyperkalemia acute coronary syndrome mesenteric thrombosis acute renal injury |
| url | https://cardiosomatics.ru/2221-7185/article/viewFile/430422/pdf |
| work_keys_str_mv | AT olgaafomina difficultiesinelectrocardiographicdiagnosisofhyperkalemiaandacutecoronarysyndromeclinicalcase AT kristinagpereverzeva difficultiesinelectrocardiographicdiagnosisofhyperkalemiaandacutecoronarysyndromeclinicalcase |