" Long QT " after droperidol

A patient presented to the ED with intractable hiccups.  He also had " ongoing GERD symptoms with heartburn......but no chest pain "  (Whatever that means).  He was treated with droperidol and benadryl and this decreased his symptoms and he was discharged.  No ECG was recorded (!).Later, the patient returned with altered mental status and reports of falls.He had an ECG recorded:The QT was 504 msThe computerized QTc (Hodges correction) was listed as 530 ms.Bazett correction would be 563 msThe providers were worried that the droperidol had resulted in a long QT.What do you think?See below for explanation.There are huge U-waves, best seen in V1-V3.  These are almost always due to hypokalemia.  Some overdoses can cause this:Cole JB, Stellpflug SJ, Smith SW: Refractory Hypotension and “Ventricular Fibrillation” With Large U Waves After Overdose (this is a great full text online case of hydroxycholorquine overdose)Here I have drawn lines at the beginning and end of the U-waves in V1-V3Then I draw them down to lead II across the bottomThen I go to sections that are under I-III, aVR-aVF, and V4-V6.Then I draw the line up through those leads to show where the U-wave is in those leads.And you can see how what may appear to be a T-wave and a long QT is really a U-wave.V4-V6 in particular show only one wave which appears to be a T-wave only.  But by showing from other leads where the U-wave vs. T-wave is, we can see that this apparent T-wave is...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs