Report:

Sinus rhythm 57/min

Early transition

J waves consistent with hypothermia

Prolonged QT interval 0.55”

QTc 0.54”

Borderline ST segment elevation

Comment:

The rate is relatively fast and there is no evidence of tremor: the patient was brain-dead. Her temperature at the time of the ECG recording was 31oC. It is noteworthy that cerebral damage can produce J waves in the absence of hypothermia192. Prolonged QT interval is itself commonly due to cerebral injury, like in Case 258. Little in ECGs is specific.

She was warmed up to 36oC and pronounced dead – “warm and dead”.

Prolonged QT Interval

Report:

Sinus rhythm 51/min

VEB

Left anterior hemiblock (QRS axis -45o)

Old anteroseptal infarct

Diffuse ST/T changes [!xe "T wave:inversion:post-LBBB-like VT" \b!]

Markedly prolonged QT interval[!xe "QT interval:sotalol" \b!]

QT 0.68" (QTc 0.62")

Comment:

The QT interval is measured from the onset of the QRS complex to the end of the T wave; it is usually corrected (QTc) for heart rate using the Bazett's formula:[!xe "QTc formula" \b!][!xe "Bazett's formula" \b!]

QTc = [formula missing] (in seconds)

The upper limit of normal for both sexes is 0.44".

The marked increase in the QTc in this patient can be attributed to sotalol, a β-blocker with Class III anti-arrhythmic activity193.

There is always a question of U wave being there as well; it is often unanswerable and seldom important. Leads V2-3 suggest that there is one, while aVL, where U wave is usually isoelectric, suggests otherwise. It may be that, as suggested by D. H. Spodick, JT interval is what should be measured instead of QT interval194.

The repolarisation changes - including the prolonged QT interval - may also be due to previous VT, which had LBBB morphology ( Fig 261a below). This would be analogous to post-LBBB or post-pacemaker (also with LBBB morphology) changes195. In fact, any paroxysmal tachycardia, like SVT, can produce transient T wave changes in subsequent sinus rhythm; this is sometimes dignified by the name of post-tachycardia syndrome.