Case history/Examination
An 84-year-old woman with a history of high blood pressure and cholecystitis on targeted antibiotic therapy in the previous 5 days was admitted to the emergency department of a hospital specialising in cardiology and cardiovascular surgery because she had an episode of syncope while sitting in another hospital without referring other symptoms to the questioning. Upon admission, his vital signs were within the normal range, with abdominal pain on palpation in the right upper quadrant of the abdomen, as well as a positive Murphy’s sign and arrhythmic heart sounds discordant with the pulse, with no other findings on the examination.
The initial ECG showed a typical atrial flutter with rapid ventricular response, with a 0.1 mV rise in SST in aVR, as well as a decrease in SST and inversion of the T wave in Dl, inferior derivatives, and from V2 to V5 (Figure 1), suggesting a possible obstructive lesion of the LMCA. In addition, acute myocardial injury was documented with high-sensitivity troponin T; however, chest pain was not documented, so it was considered secondary to the ongoing infectious process. Likewise, strikingly, severe hypokalemia was documented (1.9 meq/L), which, when corrected, showed the resolution of the initially mentioned electrocardiographic findings suggestive of a LMCA lesion, also returning to a sinus rhythm in the ECG (Figure 2).
For its part, the echocardiogram demonstrated preserved biventricular function, with a left ventricular ejection fraction (LVEF) of 61%, without contractility disorders, valvular heart disease, or other relevant findings (Figure 3). Therefore, it was considered that the electrocardiographic findings were secondary to hypocalcemia, thus completing the broad-spectrum antibiotic therapy for his cholecystitis and presenting a satisfactory clinical and paraclinical evolution during follow-up.