Severe hypocalcemia mimicking ST-segment elevation acute myocardial infarction

Abstract

Hypocalcemia is mainly the consequence of hypoalbuminemia, advanced renal impairment, cirrhosis, malnutrition, or sepsis. The most common ECG manifestation of hypocalcemia is QT prolongation as a result of ST segment lengthening. Very occasionally, hypocalcemia can manifest with ST segment elevation forcing the differential diagnosis with ST elevation MI. We described a case of severe hypocalcemia manifesting in electrocardiogram with a J point elevation, absent of ST segment and with associated short QT interval mimicking acute myocardial infarction.

Keywords: QT interval; hypercalcemia; electrocardiogram.

Figure 1

Electrocardiogram on hospital admission. Surface 12‐lead ECG on admission depicted sinus rhythm at 115–120 bpm. P‐wave abnormalities (P “mitrale”‐ bifid P wave in inferior leads II, III, aVF and leads V₂–V₆), PQ interval 160 ms, QRS duration of 90 ms, QT interval of 240 ms (limb leads), QTc interval – 320 ms, QT interval 280 ms (precordial leads), QT _apex – 160–180 ms, corrected QT _apex – 221 ms. J point elevation in lateral leads (I and aVL) with mirror J point depression in leads (II, III and aVF), absent ST segment and tall peaked T waves