Hypokalæmia, pre-VF

Report:

Sinus rhythm

Right atrial abnormality

Poor R wave progression

Probable left ventricular hypertrophy

Nonspecific ST/T changes

Prolonged QT interval ? large U waves

Somatic tremor

Comment:

Potassium was 2.0 mEq/L and the pH 7.66. Most patients with profound hypokalæmia that come to ICU never have a single VEB. This one went into VF, perhaps due to marked alkalosis. It is a moot point whether one can go into VF ab initio, without a “causal” VEB or even an “introductory” VT. This point is more semantic than electrophysiological.

Below is a later trace (Fig 294a), showing clearer separation of the U waves from the preceding T waves.

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