eng Science and Education Publishing American Journal of Medical Case Reports 2014-11-25 2 12 262 265 10.12691/ajmcr-2-12-1 AJMCR20142121 article Richard Pescatore pescatore-richard@cooperhealth.edu 1 Mark Robidoux 1 Robert Cole 2 Brett Waldman 3 Catherine Ginty 3 Department of Emergency Medicine, Cooper University Hospital, Camden, NJ USA Department of Critical Care Medicine, Cooper University Hospital, Camden, NJ USA Department of Cardiology, Cooper University Hospital, Camden, NJ USA The rapid identification and treatment of patients with ST-segment elevation myocardial infarction (STEMI) is a priority for emergency department providers. Occasionally conditions other than acute coronary syndrome (ACS) can mimic the presence of ST-elevation on electrocardiogram (ECG), making the accurate identification of these patients challenging. We present a case in which severe metabolic derangements resulted in a rare pseudo-STEMI pattern on ECG. A 26 year old male was found at home by family after a reported fall. A pre-hospital ECG conducted by EMS personnel indicated STEMI and the cardiac catheterization team was activated prior to patient arrival. Before undergoing PCI, laboratory values revealed severe hyperkalemia and rhabdomyolysis. Treatment of the patient's hyperkalemia resulted in resolution of ECG abnormalities. The patient later developed acute compartment syndrome and underwent emergent fasciotomy. This case demonstrates the rare pseudo-infarction pattern of hyperkalemia and underscores the importance of clinical context in the initial evaluation of the emergency patient. http://pubs.sciepub.com/ajmcr/2/12/1/ajmcr-2-12-1.pdf hyperkalemia Psuedo-Infarction Emergency Medicine compartment syndrome rhabdomyolysis myocardial infarction