ECG Case 096

29 yr old male presents complaining of vomiting, dizziness and felling ‘vague’.

ECG Case 096 LITFL Top 100 EKG
Venous Blood Gas

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Rate:

  • ~110 bpm

Rhythm:

  • Regular
  • Sinus rhythm

Axis:

  • Normal

Intervals:

  • PR – Normal (~120ms)
  • QRS – Normal (100ms)
  • QT – 440ms (QTc Bazett 550-600 ms)

Segments:

  • ST Elevation leads aVR, aVL and V1
  • ST Depression leads II, III, aVF, V4-6

Interpretation:

  • QTc Prolongation and ST segment changes in the setting of significant acid-base disturbance
    • Severe alkalaemia

OUTCOME

What happened?

The patient’s additional biochemistry revealed a primary hypochloraemic metabolic alkalaemia with significant acute renal failure secondary to recurrent vomiting.

He received titrated benzodiazepines for agitation and following careful re-hydration and electrolyte monitoring the patient’s ECGs normalised.

Subsequent upper GI endoscopy revealed an inflammatory gastric outlet obstruction as the cause of his recurrent vomiting.

Further Reading


TOP 150 ECG SERIES



Emergency Medicine Specialist MBChB FRCEM FACEM. Medical Education, Cardiology and Web Based Resources | @jjlarkin78 | LinkedIn |

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