Early Repolarization Augmentation Mimicking Pseudo-Infarction in a Patient With Diabetic Ketoacidosis and Normokalemia

Aleksan Khachatryan; Robert D Chow; Hakob Harutyunyan; Vahagn Tamazyan

doi:10.7759/cureus.41546

Early Repolarization Augmentation Mimicking Pseudo-Infarction in a Patient With Diabetic Ketoacidosis and Normokalemia

Cureus. 2023 Jul 7;15(7):e41546. doi: 10.7759/cureus.41546. eCollection 2023 Jul.

Authors

Aleksan Khachatryan¹, Robert D Chow¹, Hakob Harutyunyan², Vahagn Tamazyan²

Affiliations

¹ Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA.
² Department of Internal Medicine, Maimonides Medical Center, New York, USA.

Abstract

Early repolarization (ER) changes, characterized by J point elevation with or without ST-segment elevation, are dynamic in their presentation and can be exacerbated by factors such as hypothermia, hypercalcemia, vagotonia, and certain medications. There is limited research regarding the mechanism of these changes and the dynamic changes of ER secondary to diabetic ketoacidosis (DKA). This case report highlights the augmentation of early repolarization changes resembling ST-segment elevation myocardial infarction (STEMI) in a patient with DKA that resolved with the treatment of acidosis. The misinterpretation of ER changes on electrocardiogram (ECG) as STEMI or pericarditis may result in the inappropriate utilization of resources, increased patient risk, and elevated morbidity and mortality. Recognition of the potential of DKA to cause ER changes can potentially avoid these unfavorable outcomes.

Keywords: brugada syndrome; diabetic ketoacidosis; early repolarization pattern; early repolarization syndrome; j point; j wave; pseudo-infarction.

Publication types

Case Reports