Transient Left Bundle Branch Block due to Severe Hyperkalemia

Dynamic Changes of EKG by Severe Hyperkalemia: Transient Left Bundle Branch Block

Hyperkalemia is one of the most common electrolyte abnormalities seen in clinical practice and the most common life-threatening electrolyte abnormality seen in the emergency department. It is most often due to impaired renal potassium excretion due to acute on chronic kidney disease or the use of drugs that inhibit the renin-angiotensin-aldosterone axis. The most common clinical presentation is muscle weakness and cardiac conduction abnormalities. In the Emergency Department, ECG can come in handy as the first diagnosis of hyperkalemia before labs are drawn and reported. Early recognition of electrocardiographic (ECG) changes can prompt early correction and reduce mortality. We hereby, present a case of transient left bundle branch block in the setting of hyperkalemia secondary to statin-induced rhabdomyolysis.

Isolated intraventricular conduction delay in fulminant myocarditis: A case report

Introduction:

Fulminant myocarditis is uncommon. Making the diagnosis in the emergency department is difficult due to the nonspecific clinical presentation and electrocardiogram results.

Case presentation:

A 58-year-old Chinese woman presented to an emergency department with dizziness and malaise for 2 days. She was hypotensive and afebrile. Initial electrocardiogram showed isolated nonspecific intraventricular conduction delay. Despite resuscitation, she rapidly deteriorated in the emergency department and eventually succumbed. Autopsy and histological examination of heart muscle found acute inflammatory cell infiltration and multifocal necrosis, suggestive of acute fulminant myocarditis.

Discussion:

There is a wide range of differential diagnosis of nonspecific intraventricular conduction delay. Clinical presentation of mycoarditis is also often non-specific. Rapid and accurate recognition of the condition is essential to save life.

Conclusion:

Fulminant myocarditis presenting with cardiogenic shock and isolated intraventricular conduction delay on electrocardiogram poses a diagnostic challenge as illustrated in this case report.