A 65-year-old man presented to our cardiovascular department due to fatigue and palpation on exertion during the previous three weeks. He had a medical history of diabetes mellitus and hyperlipemia without hypertensio...A 65-year-old man presented to our cardiovascular department due to fatigue and palpation on exertion during the previous three weeks. He had a medical history of diabetes mellitus and hyperlipemia without hypertension or myocarditis. However, he mentioned that his son had dilated cardiomyopathy （DCM） and ankylosing spondylitis （AS）. Examination at admission revealed a blood pressure of 115/69 mmHg and pulse of 82 beats/min. The results of routine blood tests for creatine kinase （CK）, CK muscle and brain （CK-MB）, troponin T, and thyroid function were all within normal limits. ECG revealed I, aVL, and V4--6 T wave inversion （Figure 1）. Ultrasonic cardiography showed that the left ventricular ejection fraction （EF） was 32%, in- dicating ventricular wall dysfunction. Angiography showed no coronary stenosis. Radionuclide imaging demonstrated myopathy of the anterior, part of the inferior, the posterior,and the lateral apical segments based on reduced radioactivity with a patchy pattern, consistent with DCM （Figure 2A）.展开更多
Hyperkalemia is a life-threatening electrolyte disorder that often occurs in patients with chronic kidney disease(CKD)and in those using potassium-sparing diuretics.Hyperkalemia can destabilize myocardial conduction b...Hyperkalemia is a life-threatening electrolyte disorder that often occurs in patients with chronic kidney disease(CKD)and in those using potassium-sparing diuretics.Hyperkalemia can destabilize myocardial conduction by reducing the resting membrane potential,leading to increased cardiac depolarization,myocardial excitability,and arrhythmias,which can promote progress to ventricular fibrillation and asystole.[1]These patients often present with non-specific symptoms,such as fatigue and inappetence,or even sudden death.Determining the need for emergency therapy or less aggressive treatment is largely based on the patient’s electrophysiological presentation.In clinical settings,we need to differentiate hyperkalemia from hyperacute myocardial infarction,early repolarization,and pericarditis because of similarities in T-wave and ST-segment changes in the electrocardiogram(ECG).Here we present a case of hyperkalemia caused by amiloride,and discuss the ECG changes associated with an altered level of serum potassium.This case may help clinicians learn to recognize and manage patients with hyperkalemia.展开更多
文摘A 65-year-old man presented to our cardiovascular department due to fatigue and palpation on exertion during the previous three weeks. He had a medical history of diabetes mellitus and hyperlipemia without hypertension or myocarditis. However, he mentioned that his son had dilated cardiomyopathy （DCM） and ankylosing spondylitis （AS）. Examination at admission revealed a blood pressure of 115/69 mmHg and pulse of 82 beats/min. The results of routine blood tests for creatine kinase （CK）, CK muscle and brain （CK-MB）, troponin T, and thyroid function were all within normal limits. ECG revealed I, aVL, and V4--6 T wave inversion （Figure 1）. Ultrasonic cardiography showed that the left ventricular ejection fraction （EF） was 32%, in- dicating ventricular wall dysfunction. Angiography showed no coronary stenosis. Radionuclide imaging demonstrated myopathy of the anterior, part of the inferior, the posterior,and the lateral apical segments based on reduced radioactivity with a patchy pattern, consistent with DCM （Figure 2A）.
基金The authors thank Research Foundation of Beijing Friendship Hospital,Capital Medical University(No.yyqdkt2017-6)。
文摘Hyperkalemia is a life-threatening electrolyte disorder that often occurs in patients with chronic kidney disease(CKD)and in those using potassium-sparing diuretics.Hyperkalemia can destabilize myocardial conduction by reducing the resting membrane potential,leading to increased cardiac depolarization,myocardial excitability,and arrhythmias,which can promote progress to ventricular fibrillation and asystole.[1]These patients often present with non-specific symptoms,such as fatigue and inappetence,or even sudden death.Determining the need for emergency therapy or less aggressive treatment is largely based on the patient’s electrophysiological presentation.In clinical settings,we need to differentiate hyperkalemia from hyperacute myocardial infarction,early repolarization,and pericarditis because of similarities in T-wave and ST-segment changes in the electrocardiogram(ECG).Here we present a case of hyperkalemia caused by amiloride,and discuss the ECG changes associated with an altered level of serum potassium.This case may help clinicians learn to recognize and manage patients with hyperkalemia.
