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Case Report
When an arterial blood gas analysis can save an unnecessary cardiac catheterization
1 Medical Student, Kathmandu Medical College, Kathmandu, Nepal
2 Hospitalist, Department of Internal Medicine, Tower Health Sytem, Reading, PA, USA
Address correspondence to:
Saroj Lohani
355 Lackawanna Street, Apt 10-7, Reading, PA-19601,
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Article ID: 100986Z01RP2018
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Poudyal R, Lohani S. When an arterial blood gas analysis can save an unnecessary cardiac catheterization. Int J Case Rep Images 2018;9:100986Z01RP2018.ABSTRACT
Introduction: Diabetic Ketoacidosis can mimic electrocardiogram (EKG) changes of myocardial ischemia or infarction. The EKG changes of myocardial ischemia or infarction usually disappear after resolution of metabolic and electrolyte changes of DKA. We present a case in which a timely arterial blood gas analysis (ABG) prevented an unnecessary cardiac catheterization.
Case Report: An 82-year-old female with past medical history of Type 2 Diabetes Mellitus was brought to Emergency Department (ED) after she was found with agonal breathing. Electrocardiogram (EKG) en route to ED showed ST segment elevation in V1-V3.Troponin was mildly elevated. Bedside Echocardiogram did not reveal any wall motion abnormalities. ABG revealed severe metabolic acidosis. Labs showed diabetic ketoacidosis (DKA) and hyperkalemia. Her EKG changes were thought to secondary to metabolic cause rather than a cardiac etiology, and cardiac catheterization was cancelled. She was treated with intravenous fluids and insulin. EKG done the next morning revealed resolution of ST segment changes.
Conclusion: EKG changes mimicking MI can rarely be seen in DKA without myocardial damage and is called “pseudoinfarction”. The EKG changes resolve after resolution of metabolic and electrolyte abnormalities in DKA. Various theories have been proposed for pseudoinfarction pattern in DKA. The most commonly cited one is secondary to hyperkalemia in DKA. Other proposed mechanisms are secondary to metabolic acidosis or coronary artery spasm resulting from severe acidosis. Pseudoinfarction pattern in DKA is critical to recognize, since systems of care now prioritize rapid triage in treatment of STEMI that often includes bypass of emergency care and direct transfer to catheterization labs.
Keywords: Acidosis, Diabetic ketoacidosis, Electrocardiogram, Hyperglycemia
SUPPORTING INFORMATION
Author Contributions
Rakshya Poudyal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Saroj Lohani - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2018 Rakshya Poudyal . This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
