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Sinus rhythm with sinus arrhythmia (physiologic given young age)
Possible LA enlargement
Normal axis
Prominent U waves
Suspect hypokalemia. Will check serum K and Mg.
I do not count U wave when measuring QTc. What others think?
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Thanks @Mansour Khaddr !
Exactly, her K levels are shown below.
The only one more thing I would added, is that although her axis is still within normal limits, it is probably more left than should be for some one in her age where it is expected to be more vertical, and hence more prominent R-waves in lead III. In her EKG lead III has some tiny Q-waves, and inverted T-wave, which are probably related to this "subtle" axis shift in pregnancy and not due to prior MI.
In general when U wave is that prominent, K is less than 2.5 mequ/l.
When U is prominent, and relevant, like in this case I count it and label it as QT-U interval!
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That's really a great case. Life-saving!
Possible differentials for prominent U-wave:
- Electrolyte abnormalities (HYPOS: hypokalemia, hypomagnesemia and hypocalcemia).
- Anti-arrhythmic medications: for example sotalol
- Left ventricular hypertrophy.
- Sometimes we see negative or inverted U-waves with myocardial ischemia.
What is the definition of prominent U-wave?
Should we always count U-wave as part of QT prolongation and hence the increased risk of subsequent Torsade De Pointes
Comments to Bite-sized EKG #1: A pregnant young lady!
