ECG Case 285 Interpretation

This post is an answer to the ECG Case 285

  • Rate: 78 bpm
  • Rhythm: Regular Sinus rhythm
  • Axis: RAD (-33 deg)
  • Intervals:
    • PR – Normal (~170ms)
    • QRS – Normal (80ms)
    • Apparent QT – 560ms (QTc Bazette 640 ms)
      • Due to T-U fusion
      • See labelled image below

  • Additional:
    • Massive U waves
      • Mimic T waves – see labelled image below
      • Nearly merging into subsequent P waves
    • T wave inversion in leads V1-2
T and U Waves Labelled in leads V2-3

Interpretation

ECG features consistent with hypokalaemia

ECG of Hypokalemia
ECG of Hypokalemia

What happened next ?

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.

READ MORE: Hypokalemia ECG Changes [With Examples]

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