|Click to enlarge|
- 78 bpm
- Sinus rhythm
- RAD (-33 deg)
- PR - Normal (~170ms)
- QRS - Normal (80ms)
- Apparent QT - 560ms (QTc Bazette 640 ms)
- Due to T-U fusion
- See labelled image below
- Massive U waves
- Mimic T waves - see labelled image below
- Nearly merging into subsequent P waves
- T wave inversion leads V1-2
|T & U Waves Labelled in leads V2-3|
Click to enlarge
- ECG features consistent with hypokalaemia
What happened ?
The patient had urgent electrolytes which showed:
- K 1.7 [3.4 - 5.5 mmol/L ]
- Cor Cal 2.45 [2.20 - 2.55 mmol/L]
- Mg 0.73 [0.70 - 1.20 mmol/L]
She was admitted to the HDU and a PICC line inserted due to high K replacement requirements.
The patient made an uneventful recovery and was discharges once her potassium reached a consistently safe level.
For a bit more information check out:
- LitFL - You Can Beat the Feeling - A Rare Cause of (& Review of) Hypokalaemia
- NCBI - Gitelman Syndrome
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.