Click to enlarge
- 66 bpm
- Sinus arrhythmia
- PR - Normal (~130ms)
- QRS - Normal (100ms)
- QT - 410ms in lead II but 490ms in lead V2 (QTc 430/510ms)
- Prominent U waves leads I, II, V5
- Apparent biphasic T wave lead aVF
- ST Depression II, III, aVF, V3-5
- Deep T wave inversion leads V1-4
- Baseline artefact
- Number of ECG abnormalities:
- ST / T wave changes
- U waves
- QT / QTc abnormality
- Electrolyte abnormality - hypo-K / hypo-Mg
- Drug effect - QT prolongation associated with sotalol
What happened ?
This patient was hyperventilating, anxious and hypokalaemic. Shortly after this ECG she had a self-terminating run of PMVT ! Her ECG normalised following electrolyte replacement.
She was admitted under cardiology for treatment and investigation. Serial cardiac biomarkers were negative and subsequent angiogram and echo were both normal. Her sotalol was ceased due to association with QTc prolongation and risk of further PMVT.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.