Report:

Sinus rhythm

Faulty standardisation (upper left-hand corner)

Sloping ST segment depression probably due to faulty standardisation

Comment:

The repeat trace in the CCU was completely normal (Fig 201a below). Instead of receiving an apology and being sent home, the woman was kept 24 hours in the CCU, by the same Cardiologist who sent her there in the first place144!

Taking 12-lead ECGs is not always a harmless tribute to our science; much depends on who orders it and, even more importantly, who acts on it.

P-on-U Phenomenon in Hypokalæmia

Report:

Sinus rhythm

Non-specific ST/T changes

Prominent U waves consistent with hypokalæmia

Comment:

The patient was in fact hypokalæmic at 2.9 mEq/L - a frequent finding in sick alcoholics, especially after prolonged vomiting with attendant alkalosis. The ECG normalised with potassium replacement ( Fig 202a below).

T waves are flat, with prominent U waves; P waves fall on the descending limb of the U wave. The P-on-U pun is of course Schamroth’s145.