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

    Textbook

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

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