Mutlu Buyuklu

Electrocardiographic abnormality: hyperkalaemia mimicking isolated acute inferior myocardial infarction.

A 60-year-old woman with hypertension and end-stage renal failure, receiving haemodialysis three times a week, presented with dyspnoea, nausea and vomiting but no chest pain. On examination, her oxygen saturation was 98% on 2 l/min oxygen, there were a few scattered inspiratory crackles, and some mild lower limb pitting oedema. On admission, the electrocardiogram showed sinus rhythm and ST-segment elevation in leads DII, DIII and aVF (Fig. 1). Laboratory values on admission were as follows: C-reactive protein 1.1 mg/dl; white blood cell count 7.3 10/ml; serum potassium 8.7 mEq/l, serum calcium 2.98 mEq/l; serum phosphate 4.24 mEq/l; serum sodium 132 mEq/l; blood urea nitrogen 313.72 mEq/l; serum creatinine 6.94 mg/dl; pH 7.13; carbon dioxide partial pressure 16 mmHg; oxygen partial pressure 94 mmHg; serum bicarbonate 11.0 mEq/l; and oxygen saturation 90%. Myocardial enzymes were repeatedly