Several conditions may mimic acute myocardial infarction in a patient with diabetic ketoacidosis.
Patient selection: diabetic ketoacidosis (DKA)
The patient may have one of the following:
(1) the DKA was triggered by a myocardial infarction
(2) the DKA may cause a myocardial infarction
(3) the DKA may mimic a myocardial infarction
The primary cause of pseudo myocardial infarction is hyperkalemia. The ECG may show other changes of hyperkalemia. The most common pattern of ECG mimics an anterior-septal infarction. The ECG may normalize with normokalemia.
In addition, some patients may show:transient ST segment elevation that disappears after correction of hyperglycemia and acidosis. A repeat ECG will normalize soon after resuscitation.
Echocardiography can be helpful in evaluate the patient since it can detect regional wall motion abnormalities that can be seen after an infarction,
Serum troponin may be mildly elevated in patients without evidence of myocardial infarction. Serum troponin should only be measured if there are clinical reasons to suspect myocardial infarction. The differential diagnosis of an elevated serum troponin is a myocarditis associated with severe metabolic acidosis.
