Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary spasm; dramatic Oxygen reversal

Rationale: Tetany is a common, serious, well-established endocrinal and metabolic hypocalcemic disorder. Chest tetany is a novel metabolic term in hypocalcemia characterized by acute severe twisting chest pain. Movable phenomenon (Yasser’s phenomenon) is a new phenomenon that is usually associated with hypocalcemia. oxygenation may have a role in the management of coronary artery spasm. Patient concerns: A middle-aged farmer smoker male patient presented to physician outpatient clinic with tetany, mimic high lateral myocardial infarction, mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Diagnosis: Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Interventions: Electrocardiography, oxygenation, IV calcium injection, and echocardiography. Outcomes: Acute dramatic clinical and electrocardiographic improvement had happened. Lessons: The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.

Abstract 2626: Intramyocardial High-Energy Phosphate Depletion during Ventricular Fibrillation Correlates with Electrocardiographic Change

Background: Ventricular fibrillation (VF) is highly energy-wasteful, producing no perfusion. High-energy phosphates (HEPs) deplete rapidly during VF, adding to metabolic/ischemic stress and adversely affecting VF. We have shown that the scaling exponent (ScE) of the VF waveform predicts rescue shock outcome and can be used to guide decision-making during CPR. Hypotheses: We hypothesized that intramyocardial HEPs would rapidly diminish during untreated VF, and that this decrease would correlate with changes in the ScE. Methods: We anesthetized and instrumented 18 domestic swine (26.6 ± 1.9 kgs). We systematically assigned them (6 per group) to 5, 10, or 15 minutes of untreated VF, which was induced with a transthoracic shock. At the predetermined timepoint open-chest biopsies were taken from the left ventricle. Biopsied tissue samples were immediately flash frozen in a slurry of dry ice and isopentane (-90 o C), and HEPs were extracted with 1% trichloroacetic acid. Levels of ATP and ADP were measured luminometrically with an ADP/ATP ratio kit. ATP and ADP levels were assayed in duplicate, and the average recorded (reported in nmol/mg myocardial tissue). Fifteen seconds of ECG signal was digitally recorded (for ScE analysis) immediately prior to biopsy. ScE values were paired with ATP and ADP for calculation of linear regression. HEPs vs. time were compared with ANOVA. Results: Mean ATP/ADP were 1.20/0.21 at 5 min, 0.94/0.12 at 10 min, and 0.45/0.11 at 15 min. ATP correlated with ScE (r=.63, p=0.009) but ADP did not (r=.35, p=0.17). Both ATP (p=0.004) and ADP (p=0.024) differed over time. Conclusions: HEPs rapidly diminish during untreated VF. ATP depletion correlates with ScE change.