RT Journal Article
SR Electronic
T1 Lessons of the month 2: A forgotten cause of transient T-wave inversion
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 334
OP 335
DO 10.7861/clinmedicine.19-4-334
VO 19
IS 4
A1 Hala Alsafadi
A1 William Swain
YR 2019
UL http://www.rcpjournals.org/content/19/4/334.abstract
AB A 19-year-old patient presented with severe chest pain, which is not typical for cardiac angina. However, his smoking history and the strong family history of ischaemic heart disease coupled with evidence of progressive T-wave changes on his electrocardiogram (ECG) caused dilemma in deciding further management. His blood tests were normal apart from hypophosphataemia, and he had two negative troponin results. His arterial blood gases showed respiratory alkalosis. He was given analgesia for a diagnosis of musculoskeletal chest pain and the next morning his ECG, arterial blood gases and phosphate levels all normalised. He had a normal echocardiogram and was reviewed by the cardiologist who diagnosed musculoskeletal chest pain which led to distress and hyperventilation causing hypophosphataemia and transient T-wave inversion. This case is a reminder of an under-recognised physiological phenomenon involving the cardiac conduction during hyperventilation.