Key result
Fluids, diuretics, and zoledronic acid resolve ST-segment elevation mimicking MI in severe hypercalcemia.
Case Report (n=1)
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Hypercalcaemia should be considered as a differential diagnosis for ST-segment elevation mimicking myocardial infarction when clinical history and biomarkers do not support acute ischaemia, to avoid unnecessary invasive procedures.
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.
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Strand et al. (2015) conducted a case report in Hypercalcaemia-induced ST-segment elevation (n=1). Fluids, diuretics and zolendronic acid was evaluated on Resolution of ST-segment changes. Treatment of severe hypercalcaemia with fluids, diuretics, and zolendronic acid led to the resolution of ST-segment elevation that initially mimicked a myocardial infarction.
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