- 1. DR. PRIYA KUBENDIRAN M-1 UNIT PROF DR.RUCKMANIS UNIT
2. BRIEF HISTORY
- A 40 year old male was admitted on 10.08.09 with
- c/oacute watery diarrhoea 3 days
- No H/O any chest discomfort
- H/O recurrent episodes of diarrhoea over the past 4
months.
- Not a k/c of DM/SHT/PT/BA/IHD
3.
- O/E : conscious, oriented
- RS NVBS +, no added sounds
- P/A soft, no organomegaly
4. 5. ECG TAKEN ON 10.08.09
6.
- S.electrolytesNa 138 meq/l
- ELISA for HIV1 - positive
7. 8.
9.
- After adequate hydration, i.v antibiotics and corrective
measures for hypokalemia
- 3 days later repeat s.potassium 4.2 mEq/L
10. 11. REPEAT ECG ON 14.08.09
12. ECG CHANGES IN HYPOKALEMIA
- The ecg changes are due to
- DELAYEDVENTRICULARREPOLARIZATION
- Diagnosis is therefore based on ST segment, T wave & U wave
abnormalities
13.
- -progressive dimunition in amplitude, may eventually
disappear
- - a remnant of T maybe visible as a slight irregularity
(minimal upward bump) on ST segment
- progressive increase in amplitude & maintains its rounded
appearance
- may get superimposed on T-TU complex
- ST depression is seen in all leads which may be horizontal or
concave upwards
14.
- Prominent U waves combined with ST segment depression &
flattened T waves
15.
- U wave may be mistaken for a T wave leading to an incorrect
diagnosis of prolonged QT interval
- QT interval is usually unchanged
- increase in amplitude/ duration
- 1 stdegree AV block is common
- Prolongation may lead to superimposition of P on TU TUP
complex
- 2 nddegree AV block of Wenkebach type may be seen
16.
- decreased voltage & increased duration
- Atrial & ventricular ectopics
- Atrial tachycardia with block with AV dissociation
17.
- U wave amplitude > T wave amplitude in same lead
- Typical ecg :3 features in 2 leads
- Compatible ecg :2 features- U wave related characteristics is
present
18. 19.