Image in Cardiology
Misleading ST-segment elevation myocardial infarction pattern in ketoacidosis
Padrão ilusório de STEMI na cetoacidose
Lukasz Kozinski
, Monika Lica-Gorzynska, Zbigniew Orzalkiewicz
Corresponding author
Department of Cardiology, District Hospital, Chojnice, Poland
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"Misleading ST-segment elevation myocardial infarction pattern in ketoacidosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "66" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lukasz Kozinski, Monika Lica-Gorzynska, Zbigniew Orzalkiewicz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Lukasz" "apellidos" => "Kozinski" "email" => array:1 [ 0 => "lukekozinski@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Monika" "apellidos" => "Lica-Gorzynska" ] 2 => array:2 [ "nombre" => "Zbigniew" "apellidos" => "Orzalkiewicz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Cardiology, District Hospital, Chojnice, Poland" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Padrão ilusório de STEMI na cetoacidose" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 905 "Ancho" => 1623 "Tamanyo" => 265940 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) The initial ECG from an ambulance transmitted to the cardiac catheterization laboratory via the LIFENET system showing ST-segment elevation myocardial infarction pattern; (B) ECG on day of discharge.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 50-year-old man with long-standing type 1 diabetes was admitted directly to the cardiac catheterization laboratory with a preliminary diagnosis of ST-segment elevation myocardial infarction (STEMI). He presented with chest discomfort and vomiting. The initial ECG transmitted from an ambulance showed sinus tachycardia, prominent ST-segment elevation in V1–V3 and aVR and ST-segment depression in leads II, III, aVF and V5–V6 (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Prompt coronary angiography documented normal coronary arteries. Echocardiography excluded left ventricular wall motion abnormalities.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Laboratory tests revealed hyperglycemia (80.2 mmol/l, 1444 mg/dl), metabolic acidosis (pH 7.18), hyperkalemia (6.2 mmol/l), hyponatremia (118 mmol/l), ketonemia, non-significantly elevated high-sensitivity troponin (up to 210 pg/ml) and increased creatinine (272 μmol/l, 3.08 mg/dl).</p><p id="par0020" class="elsevierStylePara elsevierViewall">A diagnosis of diabetic ketoacidosis was ultimately made. The precipitating event was found to be excessive alcohol intake several days before. The ST-segment changes disappeared after normalization of water-electrolyte and acid-base imbalances (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). The patient was discharged on the sixth day after full recovery.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Direct and immediate transport to the nearest catheterization laboratory when paramedics diagnose STEMI is beneficial for most patients, nevertheless it may pose a serious threat to patients with a pseudo-myocardial infarction ECG pattern.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 905 "Ancho" => 1623 "Tamanyo" => 265940 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) The initial ECG from an ambulance transmitted to the cardiac catheterization laboratory via the LIFENET system showing ST-segment elevation myocardial infarction pattern; (B) ECG on day of discharge.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003500000001/v2_201703220342/S2174204916000088/v2_201703220342/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003500000001/v2_201703220342/S2174204916000088/v2_201703220342/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000088?idApp=UINPBA00004E" ]
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