title: Not all ST-segment changes are myocardial injury: hypercalcaemia-induced ST-segment elevation.
abstract: ST-segment elevation myocardial infarction is an important, life-threatening diagnosis that requires quick diagnosis and management. We describe the case of an 83-year-old man with coronary artery disease, ischaemic cardiomyopathy with left ventricular ejection fraction of 15%, newly diagnosed multiple myeloma that had an initial ECG showing ST-segment elevation in anterior leads V1-3 and ST-segment depression in lateral leads concerning for an ST-segment elevation myocardial infarction. Troponins were negative and his calcium was 3.55 mmol/L. It was thought that the ECG changes were not indicative of cardiac ischaemia but, rather, hypercalcaemia. He was treated with fluids, diuretics and zolendronic acid, with subsequent resolution of ST-segment changes. This case demonstrates that one must consider disease other than myocardial ischaemia as the culprit of ST-segment changes if physical examination and history do not point towards myocardial injury, as unnecessary invasive revascularisation procedures have inherent risks.
authors.affiliation: Department of Internal Medicine, Wright State University, Dayton, Ohio, USA.
authors.forename: Adam Orville
authors.initials: AO
authors.lastname: Strand
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Wright State University, Dayton, Ohio, USA.
authors.forename: Thein Tun
authors.initials: TT
authors.lastname: Aung
authors.affiliation: Department of Cardiology, Veteran Affairs Medical Center, Dayton, Ohio, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Agarwal
mesh_terms: D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D053840:Brugada Syndrome / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D000075224:Cardiac Conduction System Disease; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000008:administration & dosage; D004232:Diuretics / Q000008:administration & dosage; D004452:Echocardiography; D004562:Electrocardiography; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D007093:Imidazoles / Q000008:administration & dosage; D008297:Male; D009101:Multiple Myeloma / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D000067716:Point-of-Care Testing; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D004232:Diuretics; D007093:Imidazoles; D000077211:Zoledronic Acid; D005665:Furosemide