Acute electrocardiogram pseudoinfarction pattern and reversible left ventricular systolic dysfunction in a patient with diabetic ketoacidosis and hyperkalemia: a case report
Abstract
Coexisting myocardial infarction (MI) and diabetic ketoacidosis (DKA) are the most common causes of death in diabetic patients. We report a patient with ischemic heart disease manifestations who was finally diagnosed to have DKA as a predisposing factor. The case we present in this paper is a 57-year-old man who was found unconscious in a hotel and presented with complaints of vomiting, abdominal pain, and diarrhea. He had severe dyspnea and chest pain radiating to his back. He had ST-segment elevation in anterior leads on electrocardiogram (ECG), with non-obstructive coronary artery disease in the subsequent heart catheterization. MI patients should be treated with primary percutaneous coronary intervention (PCI) or fibrinolytic agents, but pseudoinfarction due to DKA responds to medical treatment. Thus, it is also important to know that coexistence of both DKA and MI is possible, and neglecting such situations can lead to lethal consequences.
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4. Odubanjo AA, Kalisetti R, Adrah R, Ajenifuja A, Joseph B, Zaman M. Severe myopericarditis in diabetic ketoacidosis—all troponin are not myocardial infarction. Clin Med Insights Case Rep. 2018;11:1179547618763356.
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8. Wray J, Yoo MJ, Bridwell RE, Tannenbaum L, Henderson J. ST-segment elevation in the setting of diabetic ketoacidosis: is it acute coronary syndrome? Cureus. 2020;12(3):e7409.
9. Ruiz-Morales J, Canha C, Al-Saffar F, Ibrahim S. Anterior myocardial pseudoinfarction in a patient with diabetic ketoacidosis. J Geriatr Cardiol. 2018;15(3):238-40.
10. Sweterlitsch EM, Murphy GW. Acute electrocardiographic pseudoinfarction pattern in the setting of diabetic ketoacidosis and severe hyperkalemia. Am Heart J. 1996;132(5):1086-9.
11. Abdallah M, Raza R, Abdallah T, McCord D, Khoueiry G. A rare case of silent transmural myocardial infarction with diffuse ST elevations complicated by concomitant severe hyperkalemia. Heart Lung. 2014;43(4):286-8.
12. Aksakal E, Ulus T, Bayram E, Duman H. Acute inferior pseudoinfarction pattern in a patient with normokalemia and diabetic ketoacidosis. Am J Emerg Med. 2009;27(2):251.e3-5.
13. Lim Y, Anantharaman V. Pseudo myocardial infarct--electrocardiographic pattern in a patient with diabetic ketoacidosis. Singapore Med J. 1998;39(11):504-6.
14. Roberts JD, Oudit GY, Fitchett DH. Acute coronary thrombosis in a patient with diabetes and severe hyperglycemia. Can J Cardiol. 2009;25(6):e217-9.
15. Al‐Mallah M, Zuberi O, Arida M, Kim HE. Positive troponin in diabetic ketoacidosis without evident acute coronary syndrome predicts adverse cardiac events. Clin Cardiol. 2008;31(2):67-71.
16. Levine HD, Wanzer SH, Merrill JP. Dialyzable currents of injury in potassium intoxication resembling acute myocardial infarction or pericarditis. Circulation. 1956;13(1):29-36.
17. Atabek ME, Pirgon O, Oran B, Erkul I, Kurtoglu S. Increased cardiac troponin I concentration in diabetic ketoacidosis. J Pediatr Endocrinol Metab. 2004;17(8):1077-82.
18. Geddes J, Deans K, Cormack A, Motherwell D, Paterson K, O'Reilly DSJ, et al. Cardiac troponin I concentrations in people presenting with diabetic ketoacidosis. Ann Clin Biochem. 2007;44(Pt 4):391-3.
19. Abdo AS, Geraci SA. Significance of elevated cardiac troponin I in patients with diabetic ketoacidosis. J Miss State Med Assoc. 2013;54(5):127-30.
20. Wang K. Images in clinical medicine. "Pseudoinfarction" pattern due to hyperkalemia. N Engl J Med. 2004;351(6):593.
2. Seth P, Kaur H, Kaur M. Clinical profile of diabetic ketoacidosis: a prospective study in a tertiary care hospital. J Clin Diagn Res. 2015;9(6):OC01-4.
3. Sharma AM, Wilks J, Aronow HD. Recurrent coronary artery thrombus formation in the setting of diabetic ketoacidosis. J Invasive Cardiol. 2011;23(2):E1-4.
4. Odubanjo AA, Kalisetti R, Adrah R, Ajenifuja A, Joseph B, Zaman M. Severe myopericarditis in diabetic ketoacidosis—all troponin are not myocardial infarction. Clin Med Insights Case Rep. 2018;11:1179547618763356.
5. Gerede DM, Kozluca V, Esenboga K, Aydogan BI, Tutar E. Markedly elevated troponin in diabetic ketoacidosis without acute coronary syndrome. Turk J Endocrinol Metab. 2016;20:58-60.
6. Ziakas A, Basagiannis C, Stiliadis I. Pseudoinfarction pattern in a patient with hyperkalemia, diabetic ketoacidosis and normal coronary vessels: a case report. J Med Case Rep. 2010;4:115.
7. Haseeb S, Kariyanna PT, Jayarangaiah A, Thirunavukkarasu G, Hegde S, Marmur JD, et al. Brugada pattern in diabetic ketoacidosis: a case report and scoping study. Am J Med Case Rep. 2018;6(9):173-9.
8. Wray J, Yoo MJ, Bridwell RE, Tannenbaum L, Henderson J. ST-segment elevation in the setting of diabetic ketoacidosis: is it acute coronary syndrome? Cureus. 2020;12(3):e7409.
9. Ruiz-Morales J, Canha C, Al-Saffar F, Ibrahim S. Anterior myocardial pseudoinfarction in a patient with diabetic ketoacidosis. J Geriatr Cardiol. 2018;15(3):238-40.
10. Sweterlitsch EM, Murphy GW. Acute electrocardiographic pseudoinfarction pattern in the setting of diabetic ketoacidosis and severe hyperkalemia. Am Heart J. 1996;132(5):1086-9.
11. Abdallah M, Raza R, Abdallah T, McCord D, Khoueiry G. A rare case of silent transmural myocardial infarction with diffuse ST elevations complicated by concomitant severe hyperkalemia. Heart Lung. 2014;43(4):286-8.
12. Aksakal E, Ulus T, Bayram E, Duman H. Acute inferior pseudoinfarction pattern in a patient with normokalemia and diabetic ketoacidosis. Am J Emerg Med. 2009;27(2):251.e3-5.
13. Lim Y, Anantharaman V. Pseudo myocardial infarct--electrocardiographic pattern in a patient with diabetic ketoacidosis. Singapore Med J. 1998;39(11):504-6.
14. Roberts JD, Oudit GY, Fitchett DH. Acute coronary thrombosis in a patient with diabetes and severe hyperglycemia. Can J Cardiol. 2009;25(6):e217-9.
15. Al‐Mallah M, Zuberi O, Arida M, Kim HE. Positive troponin in diabetic ketoacidosis without evident acute coronary syndrome predicts adverse cardiac events. Clin Cardiol. 2008;31(2):67-71.
16. Levine HD, Wanzer SH, Merrill JP. Dialyzable currents of injury in potassium intoxication resembling acute myocardial infarction or pericarditis. Circulation. 1956;13(1):29-36.
17. Atabek ME, Pirgon O, Oran B, Erkul I, Kurtoglu S. Increased cardiac troponin I concentration in diabetic ketoacidosis. J Pediatr Endocrinol Metab. 2004;17(8):1077-82.
18. Geddes J, Deans K, Cormack A, Motherwell D, Paterson K, O'Reilly DSJ, et al. Cardiac troponin I concentrations in people presenting with diabetic ketoacidosis. Ann Clin Biochem. 2007;44(Pt 4):391-3.
19. Abdo AS, Geraci SA. Significance of elevated cardiac troponin I in patients with diabetic ketoacidosis. J Miss State Med Assoc. 2013;54(5):127-30.
20. Wang K. Images in clinical medicine. "Pseudoinfarction" pattern due to hyperkalemia. N Engl J Med. 2004;351(6):593.
| Files | ||
| Issue | Vol 6 No 1 (2022): Winter (February) | |
| Section | Case (report / study) | |
| DOI | 10.18502/fem.v6i1.7683 | |
| Keywords | ||
| Diabetic Ketoacidosis Myocardial Infarction Pseudoinfarction Signs and Symptoms Systolic Heart Failure | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Moghtadaie A, Miratashi Yazdi SA, Ashraf H, Soleimani A. Acute electrocardiogram pseudoinfarction pattern and reversible left ventricular systolic dysfunction in a patient with diabetic ketoacidosis and hyperkalemia: a case report. Front Emerg Med. 2021;6(1):e11.
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