A female patient with hypokalaemia-induced J wave syndrome: An unusual case report

Medicine (Baltimore). 2017 Sep;96(38):e8098. doi: 10.1097/MD.0000000000008098.

Abstract

Rationale: Prominent J waves can be seen in life-threatening cardiac arrhythmias such as Brugada syndrome, early repolarization syndrome, and ventricular fibrillation. We herein present an unusual case report of hypokalemia-induced J wave syndrome and ST (a part of ECG) segment elevation.

Patients concerns: A 52-year-old woman with chief complaints of chest pain for 2 hours and diarrhea showed a marked hypokalemia (2.8 mmol/L) and slightly elevated creatine kinase-MB (CK-MB) (57.5 U/L). The electrocardiographic (ECG) recording was normal upon admission and computed tomography (CT) aorta angiography excluded an aorta dissection. ECG done 17 hours after admission showed ST segment elevation and elevated J wave in leads II, III and aVF, and fusion of T and U wave in all leads.

Diagnosis: We first thought that the diagnosis of this patient was acute myocardial syndrome.

Intervention: Potassium chloride and oflocaxin treatment was given to the patient.

Outcomes: Laboratory test showed the level of serum potassium ion increased to 3.4 mmol/L and CK-MB did not have any significant change. The infusion of potassium chloride-induced disappearance of the elevated J wave, although QT (a part of ECG) intervals were still longer than that upon admission.

Lessons: This case tells us that hypokalaemia might induce J wave and elevated ST segments which should be distinguished from acute myocardial syndrome.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Arrhythmias, Cardiac / diagnosis*
  • Arrhythmias, Cardiac / drug therapy
  • Arrhythmias, Cardiac / etiology*
  • Chest Pain / etiology
  • Diagnosis, Differential
  • Electrocardiography
  • Female
  • Humans
  • Hypokalemia / complications*
  • Hypokalemia / drug therapy
  • Levofloxacin / therapeutic use
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Potassium Chloride / therapeutic use
  • Rehydration Solutions / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Rehydration Solutions
  • Potassium Chloride
  • Levofloxacin