Hypocalcæmia
Report:
Sinus rhythm 70/min
Nonspecific lateral T wave changes
Prolonged QT interval
QTc 0.50â
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.
The patientâs calcium was quite low at 1.22 mmol/L [2.1 â 2.55], or 1.39 mmol/L adjusted for albumin of 33. Serum magnesium was also low at 0.55 mmol/L [0.7 â 0.9]. The potassium level was normal. Her echocardiogram was normal apart from mild LVH.
123. 73 year old man ventilated after laparotomy for ruptured diverticular abscess. He has a history of remote infarction and subsequent CCF.
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