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Test yourself with this week’s ECG case. Then scroll down for a structured step-by-step interpretation and clinical pearl.
A 50 year-old presented with weakness.
The ECG was interpreted as ischemia – do you agree?
Heart rate/rhythm and lead placement: NSR, lead V1/3 misplaced (P wave upright in V1 and biphasic in V3)
Electical conduction: normal QT, large U wave
Axis: normal
R-wave progression: normal besides V3
Tall/small voltages: normal
ST/T: diffuse STD, reciprocal STE-aVR
1. precordial lead misplacement
2. weak with large U wave and diffuse STD, r/o hypokalemia +/- hypomagnesemia. Potassium was 1.5 and magnesium normal
hypokalemia can cause diffuse ST depression, prominent U waves and long QT or QU
