Wavy triple sign of hypocalcemia or yasser’s sign-in diabetic ketoacidosis; reversal effect and diverse management; retrospective-observational study

Title : Wavy triple sign of hypocalcemia or yasser’s sign-in diabetic ketoacidosis; reversal effect and diverse management; retrospective-observational study

Abstract:

Aim of the study: Clarification of the effect of management of diabetic ketoacidosis on both hypocalcemia and electrocardiographic “Wavy triple sign or Yasser’s sign” is the target for the current study.

Background: Hypocalcemia is a well-known serious electrolyte disturbance characterized by calcium deficiency. Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes that is usually associated with electrocardiographic and electrolytes changes such as hypocalcemia. An electrocardiographic Wavy triple sign (Yasser’s sign) of hypocalcemia is a new diagnostic sign seen in 97.3% of hypocalcemia.

Method of study and patients: The author reported retrospective-observational 27-case report series. The study was conducted in Fraskour Central Hospital in the intensive care unit for nearly 15 months, starting on Jan 14, 2019, and, ending on Jul 12, 2020. All included cases were latent hypocalcemia. Oral calcium and vitamin D preparation on discharge was supplied.

Results: The mean age was: 44.6 years, with female sex predominance (63%). The main complaints in the study were tachypnea (81.48 %) vs. and tachypnea with chest pain (18.5%). Diabetic ketoacidosis (70.37%) and combined diabetic ketoacidosis with ischemic heart disease (11.11%) are the most common risk factors. All cases were latent tetany.  Complete electrocardiographic recovery without calcium administration in 85.19% vs. nearly normalized response in 11.11% and non-response in 3.7%.

Conclusions: The wavy triple electrocardiographic sign (Yasser’s sign) and hypocalcemia are commonly seen in diabetic ketoacidosis. Dramatic spontaneous improvement of both wavy triple an electrocardiographic sign (Yasser’s sign) and hypocalcemia simultaneously after the management of diabetic ketoacidosis in most cases.

Keywords: Wavy triple an electrocardiographic sign, Yasser’s sign in hypocalcemia, Hypocalcemia, Tetany, Diabetic ketoacidosis, Reversal effect

Biography:

Dr. Yasser Mohammed Hassanain Elsayed is a scientist, critical care physician, cardiologist, and independent researcher at the Ministry of Health in Egypt. Dr. Elsayed is an internationally known ECG expert. He has (164) publicized articles with (47) "Yasser’s Innovations". They included (9) "Yasser’s sign", (10) "Yasser’s phenomenon", (9) “Yasser’s syndrome”, (1) "Yasser’s modification", (2) "Yasser’s maneuver", (1) “Yasser’s method”, (1) “Yasser’s test”, (1) "Yasser’s fibrillation", (1) "Yasser’s procedure", (1) “Yasser’s ECG palpitations wave”, (1) Factitious Yasser's infarction, (1) "Yasser’s criterion", (1) "Yasser's conversions", (1) "Amiodarone off phenomenon, (1) "Yasser’s classification", (1) "Chest tetany", (1) “Yasser’s Cardiomyopathy”, (1) “Up-down Yasser’s alternance”, (1) “Yasser’s S1Q3 Flat T3 pattern "Yasser’s pattern”, (1) “Yasser’s ectopic and reversal”, and (1) "Yasser’s cardiac contracture". He was an international speaker in (51) Conferences, (13) Keynote speaker, reviewed (more than 359 articles), was an honorable editor for (276) Journals, (17) Conferences, OCM, and was an instructor in (17) official and (227) non-official training. He has (54) COVID-19 publicized articles; He was nominated for big prizes such as the Breakthrough Prize, the Einstein Prize, the Shoman Award, the Mostafa Prize, etc. He gained (more than 203) excellence certificates.