29 yr old male presents complaining of vomiting, dizziness and felling ‘vague’.
Venous Blood Gas
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
- ~110 bpm
- Sinus rhythm
- PR – Normal (~120ms)
- QRS – Normal (100ms)
- QT – 440ms (QTc Bazett 550-600 ms)
- ST Elevation leads aVR, aVL and V1
- ST Depression leads II, III, aVF, V4-6
- QTc Prolongation and ST segment changes in the setting of significant acid-base disturbance
- Severe alkalaemia
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.