Friday, October 21, 2011

What is the diagnosis? A nearly pathognomonic ECG.

A 50 year old woman complained of shortness of breath, but on closer questioning she seems to be weak.  An ECG was recorded immediately.  What is the diagnosis?

Answer below.

Notice large U-waves (arrows).  One is tempted to think that the long hump after the QRS (between the two vertical lines) is the T-wave.  Whenever you see this, you should think about both long QT and U-wave.  But if you look closely, you see there are 2 bumps, so the second one must be a U-wave.

The diagnosis of hypokalemia was made 1 hour prior to return of the lab value. K was 1.8.

This patient presented with hypotension, shock, acidosis, hgb of 8.  He stated he had been vomiting all day.
There is scooped ST depression in V4-V6, possibly due to ischemia, but mostly it is highly suspicious for hypokalemia.  The K was 2.6.


  1. I love this blog....It is very instructive and somehow I'm going to incorporate it into our CPC accreditation in the education component!

  2. Isolated ST depression in V4-V6 without ST depression in inferior leads go against subendocardial ischemia. Sir that is what I learned from many excellent blogs by you

    1. I'm sorry if I gave that impression. Look at #4 in the five primary patterns of ischemic ST depression:

      This pattern is ST depression limited to V3-V6, or sometimes V4-V6, without ST depression in I, II, aVF.

      Also, ST depression in "inferior" leads implies II, III, aVF. When there is ST depression in all of these leads, it is usually due to unseen ST elevation in aVL. (see #5 in the above post)


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