Is ST-segment elevation myocardial infarction (STEMI) always STEMI? Case report of a rare cause of an electric storm

Case report

A 60-year-old woman was admitted to the Catheterization Laboratory of the Cardiology Department with acute coronary syndrome with ST segment elevation of the anterior wall (STEMI anterior) complicated by sudden cardiac arrest due to ventricular tachycardia (VT). The day before the patient was admitted to the Department of Metabolic Diseases of our hospital due to dehydration (diarrhea), hypoglycemia and delirium. The patient’s previous medical history included chronic coronary syndrome, percutaneous coronary intervention of right coronary artery, circumflex artery and left anterior descending artery in 2012 and thyroidectomy due to papillary thyroid cancer in 2001. Additionally the patient had a history of hypercholesterolemia, hypertension, epilepsy, prediabetic state, alcohol dependency syndrome and depression.
At admission, the patient was conscious with disorientation and distorted perception, without chest pain or dyspnea. ST segment elevation in precordial leads and prolonged QT interval were present in ECG (Figure 1 A). Urgent angiography revealed no obstructive lesion in coronary arteries and a good outcome of previous interventions (TIMI 3 in all coronary arteries). After angiography the patient presented persistent hypotension requiring vasopressors (norepinephrine in dose 0.1–0.2 µg/kg/min). Transthoracic echocardiography was performed and revealed reduced left ventricle ejection fraction around 25% with akinetic apex, apical and medial segments of all walls, and all basal segments hyperkinetic (regional wall motion impairment like in taco tsubo cardiomyopathy). The laboratory tests revealed severe water-electrolyte imbalance (hypomagnesemia 0.6 mmol/l (N 0.66–1.07), hypocalcemia 1.35 mmol/l (2.15–2.55 mmol/l), hypokalemia 3.3 mmol/l (3.5–5.1)) and profound hypothyroidism (TSH 87.3 µIU/ml (normal range: 0.27–4.2), FT3 0.6 pmol/l (normal range: 3.1–6.8), FT4 3.7 pmol/l (normal range: 12–22)) with very low parathormone level (3.47 pmol/ml (normal range: 14.9–56.9)). Cardiac necrotic marker level was not significantly elevated, without typical dynamics for acute coronary syndrome (high-sensitivity troponin 124.71–113.49 ng/l (normal range: 47.3); CM-MB 40–53 U/l (normal range: 25). The inflammatory parameters were slightly elevated on the 1st day after admission (CRP 9.27 mg/l (< 5.00)) and negative from the 2nd day, while WBC were in the normal range (WBC 6.5 × 103/µl (N 4–10)). The chest X-ray did not reveal any...


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