<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potass...<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. <strong>Aim:</strong> This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. <strong>Methods:</strong> We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. <strong>Outcomes:</strong> Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. <strong>Conclusions:</strong> Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.展开更多
BACKGROUND： Comparison of different stroke locations had been focused in past researches in electrocardiogram （ECG） changes of cerebral stroke patients. Some researches neglected the heart disease in the illness hi...BACKGROUND： Comparison of different stroke locations had been focused in past researches in electrocardiogram （ECG） changes of cerebral stroke patients. Some researches neglected the heart disease in the illness history. OBJ ECTIVE： To discuss ECG changes in different infarction locations and size of acute cerebral infarction and compare with healthy people. DESIGN： Contrast observation SETTING： Shanghai Ninth People＇s Hospital PARTICIPANTS ： A total of 57 patients with cerebral infarction ware selected from the Neurological Department of Ninth People＇s Hospital of Shanghai from March 2003 to September 2005. They were diagnosed according to the criteria revised in the 4^th National Cerebral Disease Conference and brain images. Patients who had heart disease were excluded. There were 32 males and 25 females, who were 65-84 years old. Among them, 23 cases were involved in right hemisphere, 34 cases in left one, 23 in base ganglion, 11 in brain stem, 9 in frontal lobe and 14 in other parts. According to their infarction size （plus size in every different scan）, they were divided into three different groups： large-size group （n = 10） with size larger than 3.5 cm^3, medium-size group （n = 13） with size between 1.5-3.5 cm^3, and small-size group （n = 34） with size smaller than 1.5 cm^3. Another 50 healthy subjects were regarded as control group. There were 29 males and 21 females aged 40- 82 years. All these cases knew and agreed of the examination. METHODS ： Patients received 12-lead ECG examinations within the first 6-24 hours of onset while control group received it at the same time. The HR, PR, QTc, QRS, T wave and ST changes were compared between the two groups. MAIN OUTCOME MEASURES： The ECG changes and differences in two hemispheres, in different infarction lo- cations and sizes. RESULTS： All 57 patients and 50 healthy subjects ware involved in the final analysis. ① ECG changes in infarction group and control group. There were no differences in HR, QRS time and cases with opposite T wave of infarction group compared with control group （P 〉 0.05）. PR and QTc [（0.167±0.010）, （0.383±0.029） s] in infarction group were longer than those in control group [（0.159±0.008）, （0.361±0.022） s, t = 1.982, 2.363, P 〈 0.05, 0.01]. ST changes cases were 77% （44/57）, which was more than those in control group [46% （23/50）, x^2= 11.072, P 〈 0.01]. ② Comparison of infarction in two hemispheres. HR, PR interval, QRS time, cases with opposite T wave and ST changes showed no differences （P 〉 0.05）, and QTc interval in right hemisphere infarction was longer than left one [（0.391±0.054）, （0.380±0.034） s, t=1.673, P 〈 0.05]. ③ ECG changes in different infarction locations. HR, PR interval, QTc interval, QRS time, cases with opposite T wave and ST changes showed no statistically significantly differences （P〉 0.05）. ④ ECG changes in different infarction sizes. HR, PR interval, QRS time showed no differences （P〉 0.05）. QTc interval in large size group was longer than the others [（0.399±0.044）, （0.388±0.073）t （0.378±0.124） s, F= 3.19, P 〈 0.05]. Cases with opposite T wave and ST changes in large size group were 80% （8/10）, 100% （10/10）, which were higher than those in medium size group [46% （6/13）, 69% （9/13）] and small size group [44% （15/34）, 35% （12/34）, x^2 = 8.495, 10.538, P 〈 0.05, 0.01]. CONCLUSION ： ① PR interval and QTc interval prolonged in cerebral infarction patients. Furthermore, QTc interval was more obvious in large size infarction group and right hemisphere infarction group. ② Infarction location did not affect the changes of ECG.展开更多
文摘<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. <strong>Aim:</strong> This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. <strong>Methods:</strong> We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. <strong>Outcomes:</strong> Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. <strong>Conclusions:</strong> Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.
文摘BACKGROUND： Comparison of different stroke locations had been focused in past researches in electrocardiogram （ECG） changes of cerebral stroke patients. Some researches neglected the heart disease in the illness history. OBJ ECTIVE： To discuss ECG changes in different infarction locations and size of acute cerebral infarction and compare with healthy people. DESIGN： Contrast observation SETTING： Shanghai Ninth People＇s Hospital PARTICIPANTS ： A total of 57 patients with cerebral infarction ware selected from the Neurological Department of Ninth People＇s Hospital of Shanghai from March 2003 to September 2005. They were diagnosed according to the criteria revised in the 4^th National Cerebral Disease Conference and brain images. Patients who had heart disease were excluded. There were 32 males and 25 females, who were 65-84 years old. Among them, 23 cases were involved in right hemisphere, 34 cases in left one, 23 in base ganglion, 11 in brain stem, 9 in frontal lobe and 14 in other parts. According to their infarction size （plus size in every different scan）, they were divided into three different groups： large-size group （n = 10） with size larger than 3.5 cm^3, medium-size group （n = 13） with size between 1.5-3.5 cm^3, and small-size group （n = 34） with size smaller than 1.5 cm^3. Another 50 healthy subjects were regarded as control group. There were 29 males and 21 females aged 40- 82 years. All these cases knew and agreed of the examination. METHODS ： Patients received 12-lead ECG examinations within the first 6-24 hours of onset while control group received it at the same time. The HR, PR, QTc, QRS, T wave and ST changes were compared between the two groups. MAIN OUTCOME MEASURES： The ECG changes and differences in two hemispheres, in different infarction lo- cations and sizes. RESULTS： All 57 patients and 50 healthy subjects ware involved in the final analysis. ① ECG changes in infarction group and control group. There were no differences in HR, QRS time and cases with opposite T wave of infarction group compared with control group （P 〉 0.05）. PR and QTc [（0.167±0.010）, （0.383±0.029） s] in infarction group were longer than those in control group [（0.159±0.008）, （0.361±0.022） s, t = 1.982, 2.363, P 〈 0.05, 0.01]. ST changes cases were 77% （44/57）, which was more than those in control group [46% （23/50）, x^2= 11.072, P 〈 0.01]. ② Comparison of infarction in two hemispheres. HR, PR interval, QRS time, cases with opposite T wave and ST changes showed no differences （P 〉 0.05）, and QTc interval in right hemisphere infarction was longer than left one [（0.391±0.054）, （0.380±0.034） s, t=1.673, P 〈 0.05]. ③ ECG changes in different infarction locations. HR, PR interval, QTc interval, QRS time, cases with opposite T wave and ST changes showed no statistically significantly differences （P〉 0.05）. ④ ECG changes in different infarction sizes. HR, PR interval, QRS time showed no differences （P〉 0.05）. QTc interval in large size group was longer than the others [（0.399±0.044）, （0.388±0.073）t （0.378±0.124） s, F= 3.19, P 〈 0.05]. Cases with opposite T wave and ST changes in large size group were 80% （8/10）, 100% （10/10）, which were higher than those in medium size group [46% （6/13）, 69% （9/13）] and small size group [44% （15/34）, 35% （12/34）, x^2 = 8.495, 10.538, P 〈 0.05, 0.01]. CONCLUSION ： ① PR interval and QTc interval prolonged in cerebral infarction patients. Furthermore, QTc interval was more obvious in large size infarction group and right hemisphere infarction group. ② Infarction location did not affect the changes of ECG.
