ECG of the Week - 14th January 2019 - Interpretation

The following ECG is from a 45 yr old male who presented complaining of weakness and lethargy.

Click to enlarge

Rate:

• 48 bpm

Rhythm:

• Regular
• Sinus bradycardia

Axis:

• Normal

Intervals:

• PR - Normal (~200ms)
• QRS - Prolonged (120ms)
• QT - 620ms
• Apparent due to T-U fusion

Additional:

• ST Depression leads I, II, aVF, V2-6
• 'Down-up' T wave
• Secondary to T-U fusion
• Significant lead artifact in all precordial leads

Interpretation:

• ECG features consistent with hypokalaemia

What happened ?

The patient had a K of 1.4 mmol/L !! They were admitted to critical care for monitoring during replacement.

Hypokalemia ECG's on the Web

• ECG of the Week - We've had some examples of hypokalemia previous check them out here & here.
• Dr Smith's ECG Blog - multiple great examples of hypokalaemic ECGs here.
• Dr Ken Grauer's ECG Interpretation - A great walk through of ECG changes in hypokalaemia here.
• Amal Mattu's ECG Video - ECG findings in severe hypokalaemia here.

References / Further Reading

Life in the Fast Lane

• Hypokalaemia

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.