Electrocardiographic Manifestations of Calcium Abnormalities

Chorin, Ehud; Rosso, Raphaël; Viskin, Sami

doi:10.1111/anec.12316

Cited by 18 publications

(14 citation statements)

References 27 publications

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“…This case shows an unusual ECG pattern caused by severe hypocalcemia provoked by intoxication with HFA. The most common ECG manifestation of hypocalcemia is QT prolongation as a result of ST segment lengthening (Chorin et al., ). If the QTc exceeds >140% of the upper normal range of the QTc, it usually suggests the U wave presence that represents additional hypokalemia and cardiac repolarization will reveal a QT + U interval (Surawicz, ).…”

Section: Discussionmentioning

confidence: 99%

“…Hypocalcemia is mainly the consequence of hypoalbuminemia, advanced renal impairment, cirrhosis, malnutrition, or sepsis. The most common ECG manifestation of hypocalcemia is QT prolongation as a result of ST segment lengthening (Chorin, Rosso, & Viskin, ). Very occasionally, hypocalcemia can manifest with ST‐segment elevation forcing the differential diagnosis with ST elevation MI (STEMI) (Khardori et al., ; Reddy, Gould, & Gomprecht, ).…”

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confidence: 99%

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Severe hypocalcemia mimicking ST-segment elevation acute myocardial infarction

Kukla¹,

Kulik²,

Jastrzębski

et al. 2016

Ann Noninvasive Electrocardiol

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Hypocalcemia is mainly the consequence of hypoalbuminemia, advanced renal impairment, cirrhosis, malnutrition, or sepsis. The most common ECG manifestation of hypocalcemia is QT prolongation as a result of ST segment lengthening. Very occasionally, hypocalcemia can manifest with ST segment elevation forcing the differential diagnosis with ST elevation MI. We described a case of severe hypocalcemia manifesting in electrocardiogram with a J point elevation, absent of ST segment and with associated short QT interval mimicking acute myocardial infarction.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Severe hypocalcemia mimicking ST-segment elevation acute myocardial infarction

Kukla¹,

Kulik²,

Jastrzębski

et al. 2016

Ann Noninvasive Electrocardiol

View full text Add to dashboard Cite

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“…Variations in serum electrolyte levels, mainly [K + ] and [Ca 2+ ], have been shown to alter ventricular properties in the ECG [7], [10], [11], [40], [41]. In particular, previous studies have described that ECGs recorded under hyperkalemic conditions commonly have more peaked T waves than those recorded under normal levels of [K + ] [4], [6], [10], [42].…”

Section: Changes In the T Wave Markers When Varying [Camentioning

confidence: 99%

Characterization of T Wave Amplitude, Duration and Morphology Changes During Hemodialysis: Relationship With Serum Electrolyte Levels and Heart Rate

Bukhari

Palmieri

Ramírez

et al. 2021

IEEE Trans. Biomed. Eng.

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Objective: Chronic kidney disease affects 7 more than 10% of the world population. Changes in serum 8 ion concentrations increase the risk for ventricular ar-9 rhythmias and sudden cardiac death, particularly in end-10 stage renal disease (ESRD) patients. We characterized how 11 T wave amplitude, duration and morphology descriptors 12 change with variations in serum levels of potassium and 13 calcium and in heart rate, both in ESRD patients and in 14 simulated ventricular fibers. Methods: Electrocardiogram 15 (ECG) recordings from twenty ESRD patients undergoing 16 hemodialysis (HD) and pseudo-ECGs (pECGs) calculated 17 from twenty-two simulated ventricular fibers at varying 18 transmural heterogeneity levels were processed to quantify 19 T wave width (T w ), T wave slope-to-amplitude ratio (T S/A ) 20 and four indices of T wave morphological variability based 21 on time warping (d w , d NL w , d a and d NL a ). Serum potassium 22 and calcium levels and heart rate were measured along 23 HD. Results: d NL a was the marker most strongly correlated 24

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“…EKG of a hypercalcemic patient may also demonstrate prolongation of the PR and QRS intervals, increased amplitude of the QRS complex, Osborn (J) waves, J point elevation (including early repolarization and Brugada-type EKG), biphasic inverted or notched T waves, and prominent U waves [8,9]. In a large case series performed by Littman et al, a total of 16 cases of severe hypercalcemia with concomitant ST-segment elevation on EKGs mimicking acute coronary syndrome were described.…”

Section: Discussionmentioning

confidence: 99%

“…Hypercalcemia-induced ventricular arrhythmia is a rare phenomenon and is particularly more common in association with hyperparathyroidism. Parathormone has an independent positive inotropic as well as chronotropic effect on cardiac myocytes which, in the presence of hypercalcemia, results in decreased ventricular conduction velocity and shortened refractory period causing higher chance for re-entry and development of ventricular fibrillation [8,15]. e management of hypercalcemia depends on the severity and presence of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature

Abugroun

Tyle

Faizan

et al. 2020

Case Reports in Emergency Medicine

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ST-segment elevation in absence of acute coronary syndrome can be seen in multiple conditions, including acute pericarditis and coronary vasospasm, but it is rarely seen with severe hypercalcemia. e authors present a case of an 81-year-old female with a history of stage 4 squamous cell cancer of the lung, who presented to the emergency room with profound fatigue, weakness, anorexia, and drowsiness two weeks after her first chemotherapy cycle. Additionally, she had complaints of right-sided chest pain associated with worsening shortness of breath, as well as right arm numbness. An EKG obtained on arrival to the hospital showed diffuse ST-segment elevation (leads V3-V6, I, II, III, and aVF). Basic lab work found a calcium level of 20.4 mg/dl with elevated parathyroid hormone-related protein (PTHrP) of 135 pg/ml. Troponin I remained within normal limits. Serial EKS obtained during the patient's hospitalization demonstrated resolution of the ST elevation as calcium level normalized. is case emphasizes the importance of hypercalcemia as a differential diagnosis for ST-segment elevation and QT shortening when acute coronary syndrome is not present. Awareness of these EKG changes is critical for early diagnosis, recognition, and appropriate treatment.

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Electrocardiographic Manifestations of Calcium Abnormalities

Cited by 18 publications

References 27 publications

Severe hypocalcemia mimicking ST-segment elevation acute myocardial infarction

Severe hypocalcemia mimicking ST-segment elevation acute myocardial infarction

Characterization of T Wave Amplitude, Duration and Morphology Changes During Hemodialysis: Relationship With Serum Electrolyte Levels and Heart Rate

Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature

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