Routine ECG helps uncover electrolyte an underline clinical problem in a chronic kidney patient.
Patient Details: A 43 -year old female patient residing in Mumbai
Medical History: On dialysis for ongoing renal disease; however patient did not reveal this at the first consultation at Suburban Diagnostics.
Clinical presentation: Patient experienced a typical chest pain in the morning and came for a cardiac consultation at our center the same day on her own.
Tests done: At the center, the patient proactively requested an ECG.
Results: The ECG revealed a very rare abnormality called the long QT syndrome.
Clinical Suspicion: This raised a suspicion of arrhythmia and underlying heart disease. Dr. Ravi Chavan, the cardiologist at Suburban Diagnostics, proactively enquired with the patient. The patient revealed that she had been on dialysis for the last several years for chronic renal disease. On further probing, she also complained of having palpitations. Upon further questioning by Dr. Ravi the patient revealed that though she had been a chronic case of renal disease, she had been neglecting her investigations and had not done her renal function tests since the last several months. Dr. Ravi advised her to get her RFT done immediately to detect electrolyte imbalance which could have been the cause of the then ongoing chest pain she was experiencing.
Diagnosis based on the results: Echocardiographic confirmation of long QT syndrome suggestive of underlying electrolyte imbalance based on clinical correlation and ECG findings. Further metabolic and nephrological consultation was advised.
Significance of this case (Take home messages): At Suburban Diagnostics, we ensure that every case – whether it’s a routine ECG proactively done by a patient or any investigation ordered by a clinician is looked at very keenly, keeping in mind the clinical implications that the findings could have. In this case, the patient and her doctors were completely unaware of the presence of a long QT syndrome. The patient was counselled by our cardiologist and guided regarding the next clinical steps to be taken to address the finding of long QT syndrome.