ECG of the Week – 9th October 2017 – Interpretation

By | 11 oktober 2017

The following ECG is from a 64 yr old female who presents feeling generally unwell and weak. She has a history of pituitary lesion treated by surgical resection and radiotherapy.


Click to enlarge

Rate:

  • 48 bpm

Rhythm:

  • Regular
  • Sinus rhythm

Axis:

  • Normal

Intervals:

  • PR – Normal (~160ms)
  • QRS – Normal (100ms)
  • QT – 480ms (QTc Bazette 430 ms)
    • Note the ECG machine calculated the QT 500ms / QTc 480ms
    • Likely due to low T wave voltage plus T-U fusion

Additional:

  • Subtle ST depression in leads II, aVF
  • U wave visible in leads V2-3
  • T waves globally flat
  • Relatively long ST segment

Interpretation:

  • Changes consistent with electrolyte abnormality – differentials: 
    • Hypokalaemia – U waves, T-U fusion with QT prolongation, ST depression, low voltage T waves
    • Hypomagnesaemia – associated with hypokalaemia
    • Hypocalcaemia – causes long QT due to ST segment lengthening


What happened ?

The patient’s K was 2.7 mmol/L with a low-normal magnesium and low-normal calcium. Following IV electrolyte replacement the patients ECG changes resolved and her symptoms of weakness also resolved. 

Post pituitary surgery and/or radiotherapy complications

Surgical complications

  • GA complications
  • CSF leak
  • CNS infection
  • Post resection pituitary apoplexy
  • Hydrocephalus
  • Epistaxis
  • Olfactory sensory loss

Radiotherapy complications

  • Radiation toxicity – hypothalmic & chiasmal necrosis
  • Dermal changes

Endocrine complications

  • Central Diabetes Insipidus
  • SIADH
  • Adrenal insufficiency
  • Hypothyroidism
  • Gonadotropin deficiency


References / Further Reading

Life in the Fast Lane

Textbook

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

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ECG of the Week – 9th October 2017 – Interpretation

By | 11 oktober 2017

The following ECG is from a 64 yr old female who presents feeling generally unwell and weak. She has a history of pituitary lesion treated by surgical resection and radiotherapy.


Click to enlarge

Rate:

  • 48 bpm

Rhythm:

  • Regular
  • Sinus rhythm

Axis:

  • Normal

Intervals:

  • PR – Normal (~160ms)
  • QRS – Normal (100ms)
  • QT – 480ms (QTc Bazette 430 ms)
    • Note the ECG machine calculated the QT 500ms / QTc 480ms
    • Likely due to low T wave voltage plus T-U fusion

Additional:

  • Subtle ST depression in leads II, aVF
  • U wave visible in leads V2-3
  • T waves globally flat
  • Relatively long ST segment

Interpretation:

  • Changes consistent with electrolyte abnormality – differentials: 
    • Hypokalaemia – U waves, T-U fusion with QT prolongation, ST depression, low voltage T waves
    • Hypomagnesaemia – associated with hypokalaemia
    • Hypocalcaemia – causes long QT due to ST segment lengthening


What happened ?

The patient’s K was 2.7 mmol/L with a low-normal magnesium and low-normal calcium. Following IV electrolyte replacement the patients ECG changes resolved and her symptoms of weakness also resolved. 

Post pituitary surgery and/or radiotherapy complications

Surgical complications

  • GA complications
  • CSF leak
  • CNS infection
  • Post resection pituitary apoplexy
  • Hydrocephalus
  • Epistaxis
  • Olfactory sensory loss

Radiotherapy complications

  • Radiation toxicity – hypothalmic & chiasmal necrosis
  • Dermal changes

Endocrine complications

  • Central Diabetes Insipidus
  • SIADH
  • Adrenal insufficiency
  • Hypothyroidism
  • Gonadotropin deficiency


References / Further Reading

Life in the Fast Lane

Textbook

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

Geef een reactie

Deze website gebruikt Akismet om spam te verminderen. Bekijk hoe jouw reactie gegevens worden verwerkt.