Friday Board Review

Board Review by Dr. Hilbmann (Edited by Dr. Parikh)

A 22 year old female G1P0 with no pmhx who presents to the Emergency Department with nausea and vomiting. The patient is 11 weeks pregnant and has experienced nausea and occasional vomiting throughout her pregnancy but for the past three days she has been progressively worse and has not been able to keep any food or liquids down without vomiting. You are given her ECG, what is a finding you are looking for due to her recent presentation?

A. Hyperacute T waves
B. Shortened PR Interval
C. Prolonged QT interval
D. ST-Elevation in aVR

Answer: C.
Due to this patient’s increased vomiting, most likely due to her pregnancy, it is possible that she may be experiencing electrolyte imbalances secondary to the loss of gastrointestinal contents. Most commonly hypokalemia, hypocalcemia, and hypomagnesemia can result from continuous vomiting. In addition to blood tests, which take time to result, the levels of these three electrolytes can be evaluated with ECG as well. Physicians should evaluate for increased p waves, prolonged PR interval, ST depression, u waves, and a prolonged QT interview.

Mitchell SJ, Cox P. ECG changes in hyperemesis gravidarum. BMJ Case Rep. 2017;2017(bcr2016217158) doi: 10.1136/bcr-2016-217158.
Popa SL, Barsan M, Caziuc A, Pop C, Muresan L, Popa LC, Perju-Dumbrava L. Life-threatening complications of hyperemesis gravidarum. Exp Ther Med. 2021 Jun;21(6):642. doi: 10.3892/etm.2021.10074. Epub 2021 Apr 16. PMID: 33968173; PMCID: PMC8097228.
Image per @medicalce via Twitter

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