This post is an answer to the ECG Case 325
- Rate: 66 bpm
- Rhythm: Regular
- Axis: Normal
- Intervals:
- PR – Normal (~200ms)
- QRS – Normal (80ms)
- QT – 400ms (QTc Bazette 420 ms)
- Additional:
- Prominent U waves in leads I, II, aVF, V4-6
- T-U fusion in lead III and V2
- Causing pseudo QT prolongation if these leads are used to measure QT
Interpretation
Features favor hypokalaemia
- U waves
- T-U fusion
- Clinical scenario of likely large fluid shifts secondary to bowel prep
What happened next ?
The patients had a combination of hyponatraemia and hypokalaemia (2.4 mmol/L) and following electrolyte / volume correction her symptoms resolved. Repeat ECG showed resolution of U waves.
READ MORE: Hypokalemia ECG Changes [With Examples]
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