ECG of the Week – 14th January 2019 – Interpretation

The following ECG is from a 45 yr old male who presented complaining of weakness and lethargy.


Click to enlarge

    Rate:

    • 48 bpm

    Rhythm:

    • Regular
    • Sinus bradycardia

    Axis:

    • Normal

    Intervals:

    • PR – Normal (~200ms)
    • QRS – Prolonged (120ms)
    • QT – 620ms
      • Apparent due to T-U fusion

    Additional:

    • ST Depression leads I, II, aVF, V2-6
    • ‘Down-up’ T wave
      • Secondary to T-U fusion
    • Significant lead artifact in all precordial leads

    Interpretation:

    • ECG features consistent with hypokalaemia

    What happened ?

    The patient had a K of 1.4 mmol/L !! They were admitted to critical care for monitoring during replacement.

    Hypokalemia ECG’s on the Web

    • ECG of the Week – We’ve had some examples of hypokalemia previous check them out here here.
    • Dr Smith’s ECG Blog – multiple great examples of hypokalaemic ECGs here.
    • Dr Ken Grauer’s ECG Interpretation – A great walk through of ECG changes in hypokalaemia here.
    • Amal Mattu’s ECG Video – ECG findings in severe hypokalaemia here.


    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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