• Hala Alsafadi and William Swain.
• Royal Hampshire County Hospital, Winchester, UK and Southern Health NHS Foundation Trust, UK hala.alsafadi@hhft.nhs.uk.
• Clin Med (Lond). 2019 Jul 1; 19 (4): 334335334-335.

AbstractA 19-year-old patient presented with severe chest pain, which is not typical for cardiac angina. However, his smoking history and the strong family history of ischaemic heart disease coupled with evidence of progressive T-wave changes on his electrocardiogram (ECG) caused dilemma in deciding further management. His blood tests were normal apart from hypophosphataemia, and he had two negative troponin results. His arterial blood gases showed respiratory alkalosis. He was given analgesia for a diagnosis of musculoskeletal chest pain and the next morning his ECG, arterial blood gases and phosphate levels all normalised. He had a normal echocardiogram and was reviewed by the cardiologist who diagnosed musculoskeletal chest pain which led to distress and hyperventilation causing hypophosphataemia and transient T-wave inversion. This case is a reminder of an under-recognised physiological phenomenon involving the cardiac conduction during hyperventilation.© Royal College of Physicians 2019. All rights reserved.

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