ECG of the Week - 24th December 2012 - Interpretation

This ECG is from a 67 year old female.
Presenting with LIF pain and multiple episodes of vomitting and diarrhoea.
History of diverticulitis only, nil regular medication

Click to enlarge

Rate:

• ~66

Rhythm:

• Sinus rhythm
• Sinus arrythmia 

Axis:

• Normal (~+60 deg)

Intervals:

• PR - Normal (~140ms)
• QRS - Normal (80-100ms)
• QT - 440ms (QTc Bazette ~ 425 ms)

Segments:

• ST Elevation Leads aVR (~1mm), V1 (subtle)
• ST Depression Leads I, II, III, aVF, V3-6

Additional:

• Early R transition precordial Leads
• U waves Leads II, III, aVF, V2-6
• Notching P wave best seen lead II, although duration appears <110ms

Interpretation:

• Non-specific ST segment changes with widespread U waves
• Consider
• Ischaemia
• Hypokalaemia

 The patient had no chest pain, and serum potassium was 2.9 mmol/L

References / Further Reading

 

Life in the Fast Lane

• Hypokalaemia here

Textbook

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