A Complication of the COVID Era

Submitted and written by Gia Coleman MD and Roshan Givergis DO, edits by Meyers and SmithA woman in her 30s was found crawling in the streets, altered on arrival to the ED. Here is her presenting ECG:How would you interpret this EKG and what is on your differential?At first glance, it appears to be a sinus rhythm with PR prolongation at a rate of about 75 bpm. The QRS may appear narrow but is in fact slightly wide (see figure below). The computer measured it to be 136 ms.Perhaps the most striking finding in this EKG is the almost complete loss/flattening of the T waves. The computer calculated the QTC to be 427. Looking closer, the P waves, particularly in the precordial leads, are not of uniform morphology. Taking the flattened T waves into consideration, this made me question whether the P waves were only P waves, OR were P waves with superimposed U waves, OR only U waves. Most likely these are sinus P waves with superimposed U waves.Meyers comment: I agree, I cannot tell where the T and/or U wave is or where it ends. I don ' t think a QT interval can be meaningfully calculated here.Taking a global look at this EKG, everything just looks long, regardless of the computer calculations. The top two things on my differential when I see EVERYTHING stretched out like this is electrolyte abnormalities or toxins.The patient then progressed into an irregular wide complex rhythm which unfortunately was not captured on paper. She was treated with an amp of bicarb and an amp of ca...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs