tailieunhanh - Báo cáo y học: "Pseudoinfarction pattern in a patient with hyperkalemia, diabetic ketoacidosis and normal coronary vessels: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài:Pseudoinfarction pattern in a patient with hyperkalemia, diabetic ketoacidosis and normal coronary vessels: a case report | Ziakas et al. Journal of Medical Case Reports 2010 4 115 http content 4 1 115 jA CASE REPORTS CASE REPORT Open Access Pseudoinfarction pattern in a patient with hyperkalemia diabetic ketoacidosis and normal coronary vessels a case report Antonios Ziakas Christos Basagiannis and loannis Stiliadis Abstract Introduction A 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 presentation A 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. Conclusion ST segment elevation is a rare .