ECG of the Week - 10th December 2012 - Interpretation

This ECG is from a 69 year old male.
Have a look and think about what is going on, and what are you going to do ?

 

 

 

 

 

 

Click to enlarge

Rate:

• Ventricular Rate 42 bpm

Rhythm:

• Regular
• Nil visible p waves

Axis:

• Indeterminate
• QRS Complexes in limb leads barely visible

Intervals:

• PR - Nil p visible
• QRS - Prolonged (200ms)
• QT - 640ms (QTc Bazette ~ 510 ms)

Segments:

• Slight ST Depression V2,3
• Slight ST Elevation II, III, aVF

 
Additional:

• T Inversion aVL, aVR, V1-3, ?? V4-5
• Prominent T waves inferior leads
• T wave amplitude >>> QRS amplitude
• Low voltage

Differentials:

• Hyperkalaemia
• Toxic Drug Ingestion
• ? Cause of QT Prolongation

What happened ?

• Unfortunately I don't have any information regarding the presentation or subsequent management
• I do know that the patient's potasssium was >8.5 mmol/L !

References / Further Reading

 

Life in the Fast Lane

•  Hyperkalaemia here
• QT Interval here
• Case Study  Management Overview of Hyperkalaemia here

EMCrit

• Hyperkalaemia Podcast here

Dr Smith's ECG Blog

• Hyperkalaemia & VT A Case Review here

Textbook

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