Adding to the many faces of Hypokalemia....

These 2 cases came in on one shift:Patient 1This patient was weak with a K of 2.4 mEq/LSee the U-waves that are most prominent in V2 (which is the usual lead) and in V3-V6. I magnify the precordial leads here:Now the U-waves are much easier to seePatient 2This patient was weak with a K of 2.0 mEq/LThis ECG appears to have an incredibly long QT in V2-V4, but that apparent T-wave really is stretched out by a 2nd hump which is the U-wave.Hyperkalemia is called the " syphilis of ECG findings " because it comes in so many forms, but hypokalemia ECGs are multiform also. However, they usually some variation of U-waves.===================================MY Comment by KEN GRAUER, MD (5/8/2020):===================================I thought this to be an excellent case for reinforcing a number of important ECG concepts that we have recently reviewed. These include:How BEST to measure the QTc (Being sure to look at all 12 leads — and selecting THAT lead in which you can clearly see the end of the T wave — and in which the QT interval is longest).Appreciating that if YOU are having difficulty determining the end of the QT interval (either because of baseline artifact and/or indistinct boundaries) — then it will also be difficult for the computer! In such cases — Be AWARE that you can not trust the computer evaluation of the QTc, and YOU need to assess the QTc yourself!Being aware of the s...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs