Severe Hypercalcemia Mimicking ST-Segment Elevation Myocardial
                        Infarction

Schutt, Robert C.; Bibawy, John; Elnemr, Mina; Lehnert, Amy L.; Putney, David; Thomas, Anusha Shirwaikar; Barker, Colin M.; Pratt, Craig M.

doi:10.14797/mdcj-10-3-193

Cited by 7 publications

(9 citation statements)

References 33 publications

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“…In the present study, as frequently observed in patients with mild to moderate hypercalcemia [ 1 , 8 , 23 ], the ECG recorded from the frog heart demonstrated a prominent shortening of the QT interval 30 min after the external addition of CaCl 2 ( Fig. 2B bottom).…”

supporting

confidence: 87%

“…2B bottom). Concerning the mechanisms of such ECG changes, the decreased duration of phase 2 of the action potential, which is determined by the inward calcium flow through L-type calcium channels, is considered primarily responsible [ 23 ]. Using a mathematical model of human cardiomyocytes, Grandi et al further demonstrated that a higher calcium concentration in the extracellular fluid would facilitate the rapid influx of calcium through the channels [ 9 ].…”

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confidence: 99%

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High-calcium exposure to frog heart: a simple model representing hypercalcemia-induced ECG abnormalities

Kazama

2017

The Journal of Veterinary Medical Science

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By simply adding a high concentration of calcium solution to the surface of the bullfrog heart, we reproduced electrocardiogram (ECG) abnormalities representing those observed in hypercalcemia, such as Osborn waves and shortening of the QT interval. The rise in extracellular calcium concentration may have activated the outward potassium currents during phase 3 of the action potential, and thus decreased its duration. In addition to the known decrease in the duration of phase 2, such changes in phase 3 were also likely to contribute to the shortening of the QT interval. The dual recordings of the action potential in cardiomyocytes and the ECG waves enabled us to demonstrate the mechanisms of ECG abnormalities induced by hypercalcemia.

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supporting

confidence: 87%

mentioning

confidence: 99%

High-calcium exposure to frog heart: a simple model representing hypercalcemia-induced ECG abnormalities

Kazama

2017

The Journal of Veterinary Medical Science

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“…Acute ST-segment elevation changes caused by hypercalcaemia and mimicking a myocardial infarction have occasionally been documented in the literature, although many speculate it may be more common 19 20. Littmann et al ,19 over 14 years, identified 16 cases of hypercalcaemia leading to ST-segment elevation mimicking AMI, in a tertiary care facility in North Carolina.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Schutt et al 20 outlined nearly all of these cases (including his own). The cause of hypercalcaemia ranged from malignancy to hyperparathyroidism to vitamin D intoxication.…”

Section: Discussionmentioning

confidence: 99%

Not all ST-segment changes are myocardial injury: hypercalcaemia-induced ST-segment elevation

Strand

Aung

Agarwal³

2015

BMJ Case Reports

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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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“…J-point elevation mimicking as ST segment elevation is a common observation. [13] Transient ST segment elevation is observed in a few studies, particularly in a patient with severe hypercalcemia. Osborn wave which is usually a feature of hypothermia can also be observed in severe hypercalcemia.…”

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confidence: 99%