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This post is an answer to the ECG Case 201

• 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 in Leads I, II, V2-6
  • ST Elevation in 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.

READ MORE: Hypokalemia ECG Changes [With Examples]

SIMILAR CASES:

• ECG Case 189: Hypokalemia
• Hypokalemia in a Man With Generalized Weakness
• Hypokalemia as a result of Anorexia Nervosa and Diarrhea
• Hypokalemia that led to Ventricular Tachycardia (Torsades de pointes)