Wednesday, 31 January 2018

ECG of the Week - 29th January 2018 - Interpretation

The following ECG is from a 60 yr old male who presented with several weeks of diarrhoeal illness following foreign travel. He has a past medical history of ischaemic cardiomyopathy. His medications include warfarin, beta-blocker, PPI, ACE inhibitor and diuretics.


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Rate:
  • 60
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (130ms)
  • QRS - Normal (95ms)
  • QT - 460-480ms
Additional:
  • ST Depression leads II, aVF, V5-6
  • Normal T wave morphology
QT Prolongation Causes
  • Hypokalaemia
  • Hypomagnesaemia
  • Hypocalcaemia
  • Hypothermia
  • Myocardial ischemia
  • Post-cardiac arrest
  • Raised intracranial pressure
  • Congenital long QT syndrome
  • Drugs - multiple agents
  •  Investigations
    The patient had multiple biochemical abnormalities including:
    Sodium 136 mmol/L [135-145]
    Potassium 4.5 mmol/L [3.5-5.2]
    Urea mmol/L 8.7 [3.0-8.0]
    Creatinine 202 umol/L [60-110]
    eGFR 30 ml/min/1.73m^2
    Calcium 1.82 mmol/L [2.1-2.6]
    Albumin 48 g/L [38-50]
    Corrected Calcium 1.7 mmol/L [2.2-2.55]
    Magnesium 0.34 mmol/L [0.7-1.2]
    He was admitted for calcium replacement and following resolution of acute kidney injury his electrolytes normalised.
      
    References / Further Reading
     
    Life in the Fast Lane
    Textbook
    • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.