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Case Reports
. 2012 Oct;3(5):236-238.
doi: 10.4021/cr222w. Epub 2012 Sep 20.

Severe Hypokalemia Masquerading Myocardial Ischemia

Daniel Bogdanov Petrov  1 , Svetlozar Ivanov Sardovski  1 , Maria Hristova Milanova  1
Affiliations
Case Reports

Severe Hypokalemia Masquerading Myocardial Ischemia

Daniel Bogdanov Petrov et al. Cardiol Res. 2012 Oct.

Abstract

An advanced degree of body potassium deficit may produce striking changes in the electrocardiogram (ECG). These changes can result in incidental findings on the 12-lead ECG or precipitate potentially life-threatening dysrhythmias. Although usually readily recognized, at times these abnormalities may be confused with myocardial ischemia. The object was to report a case of severe hypokalemia mimicking myocardial ischemia. A 33-year-old, previously healthy man, presented to the Emergency Department (ED) with a progressive weakness and chest discomfort. The electrocardiogram showed a marked ST-segment depression in leads II, III, aVF, V1-V6. The initial diagnosis was non ST-elevation myocardial infarction. Echocardiography was normal and troponin levels were within normal limits. A more detailed history revealed that the patient had an episode of acute gastroenteritis with diarrhea and vomiting. Serum chemistries were notable for a potassium concentration of 1,8 mmol per liter. With aggressive electrolyte correction, the ECG abnormalities reverted as potassium levels normalized. Hypokalemia induced ST-segment depression may simulate myocardial ischemia. The differential diagnosis might be difficult, especially in the cases when ST changes are accompanied with chest discomfort.

Keywords: Hypokalemia; Myocardial ischemia; ST-segment depression.

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Figures

Figure 1
Figure 1
Admission electrocardiogram shows a marked ST-segment depression in leads II, III, aVF, V1-V6.
Figure 2
Figure 2
With aggressive electrolyte correction, the ECG changes revert to normal.
See this image and copyright information in PMC

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