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- 66 bpm
- PR - Normal (~200ms)
- QRS - Normal (80ms)
- QT - 400ms (QTc Bazette 420 ms)
- Partial RBBB Morphology
- Prominent U waves leads I, II, aVF, V4-6
- T-U fusion in lead III & V2
- Causing pseudo QT prolongation if these leads are used to measure QT
- Features favor hypokalaemia
- U waves
- T-U fusion
- Clinical scenario of likely large fluid shifts secondary to bowel prep
What happened ?
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.
References / Further Reading
Life in the Fast Lane
- Hypokalaemia - ECG features
- Hypokalaemia - Case Overview
- Hyponatraemia - Cause and Diagnostic Approach
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.