{"id":703,"date":"2017-03-28T00:01:59","date_gmt":"2017-03-28T00:01:59","guid":{"rendered":"http:\/\/torreyekg.com\/?p=703"},"modified":"2017-03-13T13:57:03","modified_gmt":"2017-03-13T13:57:03","slug":"ekg-of-the-week-48","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2017\/03\/28\/ekg-of-the-week-48\/","title":{"rendered":"EKG of the Week #48"},"content":{"rendered":"

\"\"<\/a>
\n50-year-old woman, a chronic alcoholic, with three days of nausea, vomiting and diarrhea, presents after syncope. <\/p>\n

Answer & Explanation<\/div>

\nEKG interpretation:
\n\tSinus at 70\/minute
\n\tAxis normal (10\u00b0)
\n\tPR and QRS intervals normal, QT is prolonged in many leads (eg aVL)
\n\tNo chamber enlargement
\n\tA U wave is present after the T wave in several leads (leads V2-3)\n

The important features to recognize in this EKG is the appearance of a U wave and the diminution of the T-waves, leaving the appearance of a prolonged QT in several leads. The differential of a prolonged QT interval, besides offending medications, are hypokalemia (seen with increasing U waves and diminishing T waves), hypomagnesemia, and hypocalcemia. Alcoholics are already prone to hypomagnesemia, and the addition of several days of gastroenteritis may quickly deplete other electrolytes and cations. <\/p>\n

While the patient was being monitored during the initial stages of her evaluation, she suddenly became unresponsive and the following rhythm was captured on the monitor:
\n\"\"<\/a><\/p>\n

She regained consciousness with sinus rhythm on the monitor and stable VS without intervention. Soon thereafter labs resulted:<\/p>\n

K \u2013 2.3 mEq\/L (3.6 \u2013 5.2)
\nMg \u2013 0.6 mEq\/L (1.3 \u2013 1.9)
\niCa \u2013 0.96 mmol\/L (1.1 \u2013 1.3)<\/p>\n

Remember that alcoholics who become sick are at risk for prolonged QT, torsade de pointe, and syncope or sudden death!<\/p>\n

<\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"

50-year-old woman, a chronic alcoholic, with three days of nausea, vomiting and diarrhea, presents after syncope.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-703","post","type-post","status-publish","format-standard","hentry","category-ekg-of-the-week"],"_links":{"self":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/703","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/comments?post=703"}],"version-history":[{"count":3,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/703\/revisions"}],"predecessor-version":[{"id":717,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/703\/revisions\/717"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=703"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=703"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=703"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}