title: Severe Hypokalemia Masquerading Myocardial Ischemia.
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.
authors.affiliation: Department of Emergency Cardiology and Acute Internal Diseases "Pirogov" Emergency Hospital, 21 Totleben Ave, Sofia 1606, Bulgaria.
authors.forename: Daniel Bogdanov
authors.initials: DB
authors.lastname: Petrov
authors.affiliation: Department of Emergency Cardiology and Acute Internal Diseases "Pirogov" Emergency Hospital, 21 Totleben Ave, Sofia 1606, Bulgaria.
authors.forename: Svetlozar Ivanov
authors.initials: SI
authors.lastname: Sardovski
authors.affiliation: Department of Emergency Cardiology and Acute Internal Diseases "Pirogov" Emergency Hospital, 21 Totleben Ave, Sofia 1606, Bulgaria.
authors.forename: Maria Hristova
authors.initials: MH
authors.lastname: Milanova
keywords: Hypokalemia; Myocardial ischemia; ST-segment depression