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ECG Abnormalities_Part 06

Sunday, October 10, 2010

A 23 year old female  medical student presents to the emergency room with altered mental status. Her friends say she has been drinking hard liquor non-stop for 1 week after her final exams and has not been eating well for months. She was recently started on erythromycin for a upper respiratory tract infection.
Her temperature is 37.0, blood pressure 90/50, heart rate 70, respiratory rate 10. She is thin and cachectic appearing. She is arousable but unable to answer questions or follow commands. Her heart and lung exam are normal.
Her laboratory studies reveal a potassium level of 2.1 (normal 3.5-5.0), a magnesium level of 0.9 (normal 1.8-3.0), and a calcium level of 5.0 (normal 9.0-10.5). Her ECG is below:

After a few hours in the emergency room, she becomes completely unresponsive and the monitor reveals the below rhythm:


Identify the abnormalities in 1st and 2nd ECG strips?



ECG 01 ANSWER

The ECG findings include:
1) Normal sinus rhythm
2) Prolonged QT interval
She was pre-disposed to a long QT due to hypokalemia, hypomagnesemia, hypocalcemia, erythromycin use and female gender.

ECG 02 ANSWER

Polymorphic ventricular tachycardia (Torsade de Pointes)


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20 Responses to ECG Abnormalities_Part 06

  1. Anonymous Says:
  2. in first ECG there is no obvious abnormality apperently exept for U waves which normaly occurs in hypokalemia..
    the other picture shows Torsad'e points type VF

     
  3. antonis Says:
  4. erythromycin prolongs QT segment and in patients with heart disease can cause Torsades de pointes

     
  5. azadeh Says:
  6. U wave in 1st ECG illustrates hypokalemia.
    torsades de point that specially occurs in hypomagnesemia

     
  7. Anonymous Says:
  8. 1st EKG shows U waves compatible with hypokalemia, as well as a prolonged QT interval (erythromycin and hypomagnesemia)....and the second shows a torsade de pointes VT, secondary to the previous changes

     
  9. dr baloch Says:
  10. u waves and prolonged QT interval in first ecg secondary to hypokalemia,hypomagnesemia and hypocalcemia and second ecg is torse de pointus secondary to prolonged QT interval

     
  11. Anonymous Says:
  12. 1st: Normal---
    2nd: Ventricular Fib

     
  13. ONEDO Says:
  14. PACIENTE CON HIPO K,CA,MAGNESIO Y USO DE MACROLIDO CON EKG VEO QT PROLONGADO ADEMAS IMPRESIONA ONDA U EN PRECORDIALES Y UN SEGUNDO TARZADO CON TAQUICARDIA VENTRICULAS( TORSUADES DE POINTES)DIAGNOSTICO: SINDROME QT PROLONGADO ADQUIRIDO...

     
  15. Anonymous Says:
  16. normal

     
  17. Anonymous Says:
  18. 1st:normal with u wave secondery hypomagnesemia ,hypokalmia 2nd:torsade de point occurs hypomagnesemia

     
  19. Dr:lisa Says:
  20. 1st___normal ecg with only u wave in some leads related 2 hypokalemia
    2end___ventricular tachycardia

     
  21. Anonymous Says:
  22. U wave due to hypokalemia nd prolong QT interval due to hypocalcemia hypomagnesemia.2nd ECG shows ventricular fibrilation..

     
  23. Anonymous Says:
  24. ECG 1 : Brugada syndrome?
    ECG 2 : Venticular fibrillation

     
  25. Heartbit Says:
  26. 1. Hypokalemic pattern, probably together with some else serum electrolytes reduction (Mg, Ca) and a dangerous QTc prolongation
    2. torsade de points, foreseeable in absence of treatment by the means of the previous EKG

     
  27. Anonymous Says:
  28. 1. Hypokalemic pattern, probably together with some else serum electrolytes reduction (Mg, Ca) and a dangerous QTc prolongation
    2. torsade de points, foreseeable in absence of treatment by the means of the previous EKG

     
  29. Anonymous Says:
  30. mikecicco
    qt lungo da ipopotassiemia e ipomagnesemia
    torsione di punta

     
  31. Anonymous Says:
  32. 1st. u wave,QT prolong hypo k,hypo cal,tetracyclin,hypomagnesium
    2 nd torsard de points

     
  33. Anonymous Says:
  34. 1st ECG shows the patient to be in sinus with prolonged ventricular repoarization (porlonged QT) and a prominent U-wave. Both of which could cause prolongation of the TW. the second is Torsades-De-Points, which by-the-way, should have been anticipated and electrolytes corrected before that happened........just saying.

     
  35. dr jaswant Says:
  36. 1st ecg prolonged QT probably secndry to erythrocine n electrolyte abnormlity n 2nd ecg torsa de pointes

     
  37. Anonymous Says:
  38. ECG1/ mild prolongation of QT interval
    ECG2/ torsads de pointes

     
  39. shahi islam Says:
  40. 1st ECG show u wave, prolongation of QT interval and poor prorogation of R wave.
    2nd ECG torsades de pointes.

     

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