Life-Threatening Ventricular Tachycardia and Transient Brugada-Like Electrocardiographic Abnormalities Caused by Severe Hyperkalemia Due to Urinary Retention in a 55-Year-Old Man.
Yoshiyasu Aizawa, Tomoko S Kato, Akio Kawamura
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Case in brief
A 55-year-old man without known cardiovascular disease presented with palpitations, dyspnea, and diaphoresis, then developed hemodynamically unstable sustained wide-QRS ventricular tachycardia with recurrent episodes requiring resuscitation and defibrillation. Testing showed confirmed severe hyperkalemia (7.6 mmol/L), profound metabolic acidosis, and advanced renal dysfunction. ECGs also showed marked QRS widening, terminal conduction delay, and transient right-precordial ST-segment abnormalities in V1-V2. Urinary retention was identified as the cause of postrenal acute kidney injury. Electrolyte and acidosis treatment, continuous hemodiafiltration, and bladder catheterization were followed by complete resolution without recurrence; evaluation found no structural heart disease or persistent ischemia.
What made this case unusual
Severe hyperkalemia produced both malignant ventricular tachyarrhythmia and transient right-precordial ECG changes resembling a primary arrhythmic disorder, creating potential diagnostic confusion.
Diagnostic / clinical pearl
In a patient with ventricular tachyarrhythmia and Brugada-like right-precordial changes, assess for severe hyperkalemia and reversible renal causes, including urinary retention; the ECG abnormalities may resolve when the metabolic disturbance is corrected.