ECG of the Week - 29th January 2018 - Interpretation

The following ECG is from a 60 yr old male who presented with several weeks of diarrhoeal illness following foreign travel. He has a past medical history of ischaemic cardiomyopathy. His medications include warfarin, beta-blocker, PPI, ACE inhibitor and diuretics.

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Rate:

• 60

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal

Intervals:

• PR - Normal (130ms)
• QRS - Normal (95ms)
• QT - 460-480ms

Additional:

• ST Depression leads II, aVF, V5-6
• Normal T wave morphology

QT Prolongation Causes

Hypokalaemia

Hypomagnesaemia

Hypocalcaemia

Hypothermia

Myocardial ischemia

Post-cardiac arrest

Raised intracranial pressure

Congenital long QT syndrome

Drugs - multiple agents

 Investigations

The patient had multiple biochemical abnormalities including:

Sodium 136 mmol/L [135-145]

Potassium 4.5 mmol/L [3.5-5.2]
Urea mmol/L 8.7 [3.0-8.0]
Creatinine 202 umol/L [60-110]
eGFR 30 ml/min/1.73m^2

Calcium 1.82 mmol/L [2.1-2.6]

Albumin 48 g/L [38-50]
Corrected Calcium 1.7 mmol/L [2.2-2.55]

Magnesium 0.34 mmol/L [0.7-1.2]

He was admitted for calcium replacement and following resolution of acute kidney injury his electrolytes normalised.
  

References / Further Reading

 

Life in the Fast Lane

• Hypomagnesaemia
• Hypocalcaemia

Textbook

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