2024 Volume 73 Issue 3 Pages 566-572
We experienced a case of electrocardiogram (ECG) changes with a shark fin sign pattern, accompanied by hypokalemia and Takotsubo cardiomyopathy (TTC)-like myocardial damage. Case: A woman in her 80s was brought to the emergency department after experiencing lower limb weakness and a fall. Blood tests revealed that she had metabolic alkalosis with hypokalemia. ECG after admission showed ST-segment elevation with a triangular QRS-ST-T complex in the chest leads. Transthoracic echocardiography revealed severe wall motion depression at the apex of the heart and TTC was strongly suspected. Coronary angiography was not performed because the patient was asymptomatic and considered not to be a candidate for cardiac catheterization due to the course of hospitalization, malnutrition, and age. After potassium correction, ECG changes and wall motion abnormalities improved, indicating that ECG changes accompanied by the Shark fin sign were associated with TTC. The shark-fin sign is known as a specific indicator of acute coronary syndrome and extensive myocardial ischemia, and is associated with an increased risk of ventricular fibrillation, cardiogenic shock, and high mortality. Shark fin signs are rarely observed in hypokalemia and TTC. It is extremely important to keep in mind that characteristic ECG changes such as the one that occurred this time appear in a different pathological condition than usual, and to prepare for tests and treatments as necessary.
