Hypocalcæmia in Painless Pancreatitis
Report:
Sinus rhythm.
LVH voltage.
Non-specific T wave changes 1 & aVL.
Prolonged QT interval 0.53".
Q3 and borderline ST segment elevation 2, 3, aVF.
Comment:
This was an unusual presentation of acute pancreatitis (proven by means of a CAT scan) presenting with profound hypocalcæmia without abdominal pain or amylase/lipase elevation. The patient was admitted to the CCU because of the prolonged QT interval and hypocalcæmia, on the mistaken presumption that arrhythmias may occur in this setting. If they did, this patient would still have been better off in ICU.
The non-specific T wave changes in the lateral leads include inversion in aVL (with R wave exceeding 5 mm) and the flat T1 being smaller than T3. It may be a sign of coronary disease or, in this case, early LVH.
The QT interval should not exceed 0.37" at the observed heart rate of 82/min. Correction for rate is best read from tables or nomograms, or calculated by Bazett's formula155. A useful rule of the thumb is that the T wave should not encroach on the second half of its R-R interval.
Hypocalcæmia, unlike other causes of QT prolongation, leaves the T wave relatively unchanged. The temporal dispersion of repolarisation potentials is minimal: hence the rarity of ventricular arrhythmias156.
Pseudoinfarction patterns in the inferior leads have been described in pancreatitis157.The inferior q waves here do not make it.
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