title: Hyperkalemia masked by pseudo-stemi infarct pattern and cardiac arrest.
abstract: BACKGROUND
  Hyperkalemia is a common electrolyte abnormality and has well-recognized early electrocardiographic manifestations including PR prolongation and symmetric T wave peaking. With severe increase in serum potassium, dysrhythmias and atrioventricular and bundle branch blocks can be seen on electrocardiogram. Although cardiac arrest is a worrisome consequence of untreated hyperkalemia, rarely does hyperkalemia electrocardiographically manifest as acute ischemia.
  
  
  METHODS
  We present a case of acute renal failure complicated by malignant hyperkalemia and eventual ventricular fibrillation cardiac arrest. Recognition of this disorder was delayed secondary to an initial ECG pattern suggesting an acute ST segment elevation myocardial infarction (STEMI). Emergent coronary angiography performed showed no evidence of coronary artery disease.
  
  
  CONCLUSIONS
  Pseudo-STEMI patterns are rarely seen in association with acute hyperkalemia and are most commonly described with patient without acute cardiac symptomatology. This is the first such case presenting concurrently with cardiac arrest. A brief review of this rare pseudo-infarct pattern is also given.
authors.affiliation: Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, 77030, TX, USA.
authors.forename: Shareez
authors.identifier: http://orcid.org/0000-0002-5386-1459
authors.initials: S
authors.lastname: Peerbhai
authors.affiliation: Department of Internal Medicine, Section of Cardiology, The University of Texas Health Science Center at Houston, Houston, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Masha
authors.affiliation: Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, 77030, TX, USA.
authors.forename: Adrian
authors.initials: A
authors.lastname: DaSilva-DeAbreu
authors.affiliation: Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, 77030, TX, USA. Shareez.Peerbhai@uth.tmc.edu.|Department of Internal Medicine, Section of Cardiology, The University of Texas Health Science Center at Houston, Houston, USA. Shareez.Peerbhai@uth.tmc.edu.
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Dhoble
keywords: Cardiac arrest; ECG; Hyperkalemia; Myocardial infarction; STEMI