Aldosteronism with mild hypokalemia presenting as life-threatening ventricular arrhythmias A case report

Rationale: Primary aldosteronism (PA) with hypokalemia increases the risk of life-threatening ventricular arrhythmias. Cases of PA with malignant arrhythmia as the first symptom have been reported. The role of severe hypokalemia in triggering malignant ventricular arrhythmia is well documented. However, few cases of PA with mild hypokalemia that presented with life-threatening ventricular tachycardia have been reported. Patient concerns: A 74-year-old man was admitted to our hospital 25hours after suffering from syncope caused by ventricular tachycardia without chest pain. Electrocardiogram showed ST segment depression and T wave inversion in leads III, avF, V4-V6. Mild QT prolongation was observed during sinus rhythm. Blood tests showed mild hypokalemia and elevated plasma aldosterone level. Abdominal computed tomography showed a nodule in the left adrenal gland. Coronary angiography revealed stenosis in the right coronary artery. Diagnosis: Prolonged QT interval, hypokalemia, high level plasma aldosterone, a nodule in the left adrenal gland and right coronary artery stenosis led to a diagnosis of aldosterone hyperplasia and adrenal nodule with ischemic heart disease. Intervention: Intravenous potassium and magnesium were administered to correct hypokalemia and a stent was implanted in the right coronary artery for vascularization. A prescription aldosterone receptor antagonist, spironolactone, was prescribed for hyperaldosteronemia. Outcomes: During 6 months of follow-up, no episodes of ventricular tachycardia or syncope occurred, and serum potassium level remained normal. Lessons: In patients with ventricular tachycardia and mild hypokalemia, physicians need to consider that PA and ischemia heart disease may be one of the possible causes of electrical storm.