Pseudoinfarction Pattern Associated with Electrolyte Disturbance

Introduction The electrocardiographic changes associated with hyperkalemia have been well documented by previous writers.1-4These changes include (1) peaking of the Twaves; (2) increased depth of the S-wave, with lowering of the R-wave; (3) widening and then loss of P-waves; (4) ST-segment elevation associated with intraventricular conduction disturbances, resulting in a widened QRS complex; (5) prolongation of P-R interval, and (6) ventricular arrhythmias. Myers5has described an ECG pattern simulating myocardial infarction associated with hyperkalemia. Recently Levine et al.6likewise have described the electrocardiographic changes of acute myocardial infarction associated with hyperkalemia. In recent months we have had two cases similar in several respects to those of Levine in that they showed transient electrocardiographic patterns consistent with myocardial infarction. One of these ECG's has a pattern more suggestive of an "old" rather than recent infarction, and the second ECG presented an atypical pattern. At autopsy the first