{"id":29447,"date":"2019-04-10T09:27:43","date_gmt":"2019-04-10T09:27:43","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=29447"},"modified":"2024-01-31T13:52:02","modified_gmt":"2024-01-31T08:22:02","slug":"ecg-quiz-56-discussion","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-56-discussion\/","title":{"rendered":"QT Prolongation Due to ST Prolongation"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/FVIiGrUmRLU?si=bfFa3Cc3ilC0a_dA\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n<h2><span style=\"color: #008000;\">ECG Quiz 56 &#8211; Discussion<\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-29448\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/04\/ECG56A.jpg\" alt=\"\" width=\"1906\" height=\"729\" \/><\/p>\n<p style=\"text-align: center;\"><strong><a href=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/04\/ECG56A.jpg\">Click here for a larger image<\/a><\/strong><\/p>\n<p>ECG shows QT interval prolongation with a QTc of around 500 ms. T waves are flat in inferior and lateral leads. The speciality of QT prolongation in this case is that ST segment is more prolonged compared to width of QRS and T wave. Such ST prolongation should alert us about hypocalcemia because the effect of calcium is mainly in the plateau phase or phase 2 of the cardiac action potential and corresponds to the ST segment. In hypokalemia T wave amplitudes are reduced and U waves become prominent, causing an apparent QT prolongation.\u00a0 Here prominent U waves are not seen, though T wave amplitude is reduced in inferior and lateral leads. ST segment depression is noted in inferior and lateral leads, with minimal ST elevation in aVR.<\/p>\n<p>This could be due associated ischemic heart disease or even due to hypokalemia. When a combination of findings of hypocalcemia and hypokalemia are seen, a common cause should be considered. Hypomagnesemia is a condition which can cause both hypokalemia and hypocalcemia as the enzyme needed for renal transport of these electrolytes has magnesium as\u00a0 cofactor. Hence correction of magnesium levels could rectify both hypokalemia and hypocalcemia. As a corollary, it is often difficult to correct hypokalemia when there is associated hypomagnesemia, which is considered as a cause for refractory hypokalemia. These type of ECGs are often seen elderly with multiple comorbidities when it is difficult to delineate whether it is solely due to ischemia or electrolyte abnormality as they may have both!<\/p>\n<p><a href=\"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-56\/\"><strong>Back to ECG Quiz 56<\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>ECG Quiz 56 &#8211; Discussion Click here for a larger image ECG shows QT interval prolongation with a QTc of around 500 ms. T waves are flat in inferior and lateral leads. The speciality of QT prolongation in this case is that ST segment is more prolonged compared to width of QRS and T wave. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":29448,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6,7],"tags":[],"class_list":["post-29447","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology","category-ecg-library"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>QT Prolongation Due to ST Prolongation - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/ecg-quiz-56-discussion\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"QT Prolongation Due to ST Prolongation - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"ECG Quiz 56 &#8211; Discussion Click here for a larger image ECG shows QT interval prolongation with a QTc of around 500 ms. T waves are flat in inferior and lateral leads. The speciality of QT prolongation in this case is that ST segment is more prolonged compared to width of QRS and T wave. 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