ECG of the Week - 11th March 2013 - Interpretation

This week's ECG is from a 57 year old female.

 

I don't have any presenting complaints for this case but it is likely she would complain of weakness.

 

 

Click to enlarge

Rate:

• 60 bpm

Rhythm:

• Sinus Arrhythmia

 
Axis:

• Normal (50 deg)

Intervals:

• PR - Prolonged (~220ms)
• QRS - Normal (100ms in lead II, prolonged in lead V2)
• Apparent QT - 680ms (QTc Bazette ~ 710 ms)

Segments:

• ST Depression Leads I, II, V2-6
• ST Elevation aVR

Additional:

• Ventricular Ectopic
• Prominent U waves
• T-U Fusion
• Best visualised in leads II, III, aVF, V2-6
• Initial T wave is inverted and merges with large U wave
• Results in apparent QT prolongation due to fusion
• Best considered QU prolongation

Interpretation:

 

• Multiple ECG features consistent with hypokalaemia +/- hypomagnesaemia

 
This patient had a K+ of 1.6 mmol/L confirmed by a VBG, result below.
 

 
 
References / Further Reading

 

Life in the Fast Lane

• Hypokalaemia ECG here
• Hypokalaemia cases
• You Can Beat the Feeling
• D&V Now can't stand up
• Hypokalaemia & Metabolic Acidosis
• Hypokalaemia overview

Textbook

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