Case 145: A 43-Year-Old Man in the Nephrology Clinic
History
Diagnosis
History
This 43-year-old man with diabetes, hypertension, and end-stage diabetic nephropathy on dialysis presents to the nephrology clinic for routine follow-up:
Diagnosis
- Sinus rhythm
- Left atrial enlargement
- Left ventricular hypertrophy with repolarization abnormality
- ST elevation in V2 and V3, probably reciprocal to the “strain pattern” of LV. Clinical correlation is advised
- Prolonged QTU (QT 444 msec, QTc 506 msec) with prominent U waves. Consider hypokalemia.
There is ST elevation in V2-V3, reciprocal to the ST depression of left ventricular hypertrophy. This had been noted during previous routine assessments, in the absence of any cardiac symptoms. The patient had been given a copy of his ECG, to allow for comparison in case of an Emergency visit to a different hospital. Notice the prominent U waves in II, III, aVF, V5 and V6. The serum potassium was checked, and found to be moderately low (3.2 mmol/L).
ECG ID: E233