ECG Case 096

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

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

• Metabolic alkalosis overview
• Hypochloraemia
• Hypocalcaemia ECG features