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VOLUME 18 NUMBER 1 • JULY 2021
11
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Case Report
thromboembolic events, as would happen with other arrhythmias
such as atrial fibrillation.
2,6
Treatment of AS depends on clinical consequences and the
underlying cause. If the patient shows important signs of heart
failure, treatment with diuretics and vasodilators is indicated, as
well as positive chronotropic drug infusion, such as isoproterenol,
for a limited time as a supportive measure while the underlying
condition that gave rise to the AS is corrected.
Temporary transvenous pacing should be deferred and only used
as a last resort if chronotropic drugs are insufficient, in cases of a
high-degree atrioventricular block without escape rhythm, and for
pacing in cases of pause-related ventricular arrhythmias.
Temporary transcutaneous pacing should be avoided, as pacing
provided by patches and an external defibrillator does not provide
reliable ventricular stimulation and should only be used under strict
monitoring when no other option is available.
7
Conclusion
Severe hyperkalaemia in the context of acute kidney injury was the
most likely cause of AS in this case. We highlight three learning
points: (1) AS is an uncommon but potentially hazardous condition,
which can present as a complication of diabetic ketoacidosis;
(2) diagnosis of AS can be made with readily available tools in
any emergency room, such as ECG and echocardiography; (3)
Fig. 1. A:
Initial ECG showing slightly irregular junctional rhythm and absence of atrial electrical activity.
B:
ECG showing sinus rhythm after metabolic and electrolyte
correction.
A
B