An under 30 yo woman collapsed and was found in ventricular fibrillation, and was successfully defibrillated.
Here is her prehospital ECG:
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgl9-84ThuPTnGz9BSlsSCMdbX1-9ISq6ETuEFyahlEqC0Juc1PVPvi-26vBNG7vaorIf9GmbkUbzIuSJyJXKBVztGoJOP37H7Bc6J4xT45E5-4PU-M51WyfmiclCtmZDlMBth2ikNBak/s640/Prehospital_ECG.png) |
What is it? |
ECG diagnosis: There is sinus rhythm. There is what I call a "wavy" pattern and large U-waves (see arrow). Do not mistake the U-wave for a T-wave, or the long Q-U interval for a long QT. This is diagnostic of hypokalemia. The K was 1.3 mEq/L.The patient eventually recovered.
Here are more ECGs of hypokalemia which demonstrate the "wavy" pattern:
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaWONzSAXLG3LawXfdO_aQSySyn5DaShSOJIj6J8JLI_aOpkCQVj9wN9cmZds62YFzE-3zRpNkM_6MqRQInk0uE-lzff7Gr5YoxG9b5UcbADnxfG9XY28zbvkzS-69MB6rxlJI4s4cclA/s640/Additional_hypo_K_case_from_K_Wang.jpg) |
Notice the "wavy" pattern in V2 and V3, created by downsloping ST depression followed by the U-wave. |
When there is an apparent T-wave with an apparent
"down-up" pattern (in
contrast to an up-down pattern, as in Wellens'), the terminal "up"
portion is almost always NOT a T-wave, but rather a U-wave. There is
one exception to this: when the down-up is actually reciprocal to an up-down: this happens with Wellenesque T-waves in opposite leads aVL and III: Wellenesque up-down T-wave in lead III, indicative of inferior Wellens' waves (and thus inferior Non-STEMI), will have a
reciprocal down-up in lead aVL and vice versa.
Here is another:
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYDysKSjJ_ENFMIrYHSxcn0G7EQrPf7XMHq5mDf4cGtVqn8uQpDMln65ZpiN9HcJbW8KYKHIyFwjq9ERZ3OCcsZ3kOOEUOx1DOc3OFa0CdhoYvTNUIS_dMHVzfeZP-nxNA5ypXrxzsyBI/s640/K+1+point+4.jpg) |
K = 1.4. Notice again the wavy pattern in almost all leads, with down-up. The end of each wave is the (upright) U-wave.
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![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuaktyoeXqmEX03sKEQk56okPXoEvj3ohRz85xbGO_sd8t9eR98fACDipxMacPIieoXj-3NjosYSvlbkex_8ie9x4oiA-RcwwHLlM4RFibKATyXvjAbPT8dFT6wzqMuK_IyF_94Ktgfis/s640/K+2+point+3+wavy+U+waves.jpg) |
K = 2.3. Again, the wavy pattern. |
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Here are
more cases of hypokalemia, some of which mimic ischemia.
This ekg looks similar to a Brugada type I . Granted there is not a coved st elevation, however there is a long downslope to the t wave and also the coved st segment might be misinterpreted in a wandering baseline.
ReplyDeleteWhat you're seeing really is all due to wandering baseline.
Deletethank you, Steve
ReplyDelete