Severe Hyponatraemia: A STEMI Mimic

Abstract

ST segment elevation can be found in patients presenting with or without chest pain. We reported a case of ST segment elevation caused by severe hyponatraemia. A middle age Malaysian, newly diagnosed pulmonary tuberculosis on treatment, presented with nausea and vomiting for a week. He had no anginal symptoms. He was clinically dehydrated. His electrocardiogram showed ST segment elevation with Q wave at V1-V4 as well as T wave inversion at leads I and aVL. Bedside echocardiography revealed good LV contractility but a hypokinetic septal wall. Cardiac enzymes were within normal limit. He was hydrated with intravenous fluid. The diagnosis was revised to severe hyponatraemia instead of STEMI or TB myopericarditis when the sodium level came back as 98mmol/L. He improved clinically with hydration over days and his ECG normalized when the sodium level normalized. As the treatment for hyponatraemia induced ST segment elevation differ from ST elevation myocardial infarction, it is equally important to identify the exact cause of ST segment elevation.