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Electrocardiogram in a 75-Year-Old Woman With Left-Sided Chest Pain
ARTICLE IN PRESS Electrocardiogram in a 75-Year-Old Woman With Left-Sided Chest Pain Mazen M. Kawji, MDa, and D. Luke Glancy, MDb,* In a 75-year-old woman with left-sided chest pain and an abnormal electrocardiogram the etiology is not cardiac. © 2019 Elsevier Inc. All rights reserved. (Am J Cardiol 2019;00:1−1)
Case Report A 75-year-old woman with known mild aortic stenosis, left bundle branch block (LBBB), a left ventricular ejection fraction of 45%, and a history of breast cancer presented with left-sided chest pain that could be reproduced by pressure on the left side of her chest. Her initial electrocardiogram (ECG) is in Figure 1. The rhythm is sinus with a P-R interval of 0.20 seconds. LBBB is present. The interval from the onset of the QRS to the onset of the T wave (the Q-oTc interval) is short indicating a brief ST segment and consequently a short QT interval, especially in the presence of LBBB, which increases the QT interval. These findings suggest hypercalcemia. A study
by Bronsky et al found that in hypercalcemia the Q-oTc interval was inversely proportional to the serum calcium concentration.1 This patient’s serum calcium concentration was 16.2 mg/dL. The cause was revealed by a computed tomogram of the chest, which showed many bony metastases in her spine and ribs, with a pathological fracture of the left ninth rib. The reproducible nature of the pain with pressure suggested skeletal pain rather than cardiac pain. 1. Bronsky D, Dubin A, Waldstein SS, Kushner DS. Calcium and the electrocardiogram II. The electrocardiographic manifestations of hyperparathyroidism and of marked hypercalcemia from various other etiologies. Am J Cardiol 1961;7:833–839.
Figure 1. Initial electrocardiogram in a 75-year-old woman with left-sided chest pain. See text for explication.
a Heartland Cardiovascular Center, Silver Cross Hospital, New Lenox, Illinois; and bSection of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana. Manuscript received October 4, 2019; revised manuscript received and accepted October 7, 2019. *Corresponding author: Tel: (985) 796-1550; fax: (504) 568-2127. E-mail address: [email protected] (D.L. Glancy).
0002-9149/© 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.amjcard.2019.10.007
www.ajconline.org
Case Report A 75-year-old woman with known mild aortic stenosis, left bundle branch block (LBBB), a left ventricular ejection fraction of 45%, and a history of breast cancer presented with left-sided chest pain that could be reproduced by pressure on the left side of her chest. Her initial electrocardiogram (ECG) is in Figure 1. The rhythm is sinus with a P-R interval of 0.20 seconds. LBBB is present. The interval from the onset of the QRS to the onset of the T wave (the Q-oTc interval) is short indicating a brief ST segment and consequently a short QT interval, especially in the presence of LBBB, which increases the QT interval. These findings suggest hypercalcemia. A study
by Bronsky et al found that in hypercalcemia the Q-oTc interval was inversely proportional to the serum calcium concentration.1 This patient’s serum calcium concentration was 16.2 mg/dL. The cause was revealed by a computed tomogram of the chest, which showed many bony metastases in her spine and ribs, with a pathological fracture of the left ninth rib. The reproducible nature of the pain with pressure suggested skeletal pain rather than cardiac pain. 1. Bronsky D, Dubin A, Waldstein SS, Kushner DS. Calcium and the electrocardiogram II. The electrocardiographic manifestations of hyperparathyroidism and of marked hypercalcemia from various other etiologies. Am J Cardiol 1961;7:833–839.
Figure 1. Initial electrocardiogram in a 75-year-old woman with left-sided chest pain. See text for explication.
a Heartland Cardiovascular Center, Silver Cross Hospital, New Lenox, Illinois; and bSection of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana. Manuscript received October 4, 2019; revised manuscript received and accepted October 7, 2019. *Corresponding author: Tel: (985) 796-1550; fax: (504) 568-2127. E-mail address: [email protected] (D.L. Glancy).
0002-9149/© 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.amjcard.2019.10.007
www.ajconline.org