ECG findings in severe hypokalemia that may mimic ACS

ECG Weekly Workout with Dr. Amal Mattu


An 85-year-old woman with PMHx of atrial fibrillation is referred to the ED by her primary care physician who is concerned for cardiac ischemia. The patient has been having epigastric pain, generalized weakness, vomiting and diarrhea. The following prehospital ECG was obtained:

Before watching this week’s video, ask yourself these questions:

  1. What ECG abnormalities do you notice?
  2. Are there signs of acute cardiac ischemia?
  3. What is the most likely cause of the biphasic T wave pattern seen in the precordial leads?