Hypocalcæmia
Report:
Sinus rhythm 70/min
Nonspecific lateral T wave changes
Prolonged QT interval
QTc 0.50”
Comment:
Although the QT interval is prolonged, the T wave is usually fairly normal in hypocalcæmia. This may explain the rarity of torsades de pointes: the repolarisation is delayed, but not dispersed. In this trace, there is a vertical heart position (aVL and aVF converge), making T3 > T1 a normal variant. However, this is more than that: T1 is not just smaller than T3, it is shallowly inverted. This may represent hypertensive or ischæmic heart disease.
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