Tremor on the Electrocardiogram
The ECG of a 41-year-old man is shown (Figure 1⇓). The patient has a history of C6 quadriplegia requiring a chronic indwelling urinary catheter. He presented with a temperature of 40.2°C, pyuria, hyperkalemia, and pronounced generalized tremor. Confusion over the patient’s cardiac rhythm was resolving by 3 cardiac electrodes placed vertically on the right leg. The rhythm strip (Figure 2⇓) confirmed that the depolarizations at a rate of 420 bpm represented tremor. The ECGs were obtained when the patient was not connected to any mechanical device, such as an intravenous accurate control device machine.
Treatment with antipyretics, antibiotics, and muscle relaxants decreased the tremor intensity. Further workup revealed hypomagnesemia at 1.2 mg/dL (normal, 1.5 to 2.0 mg/dL) and hypomagnesuria at 26 mg/24 h (normal, 28 to 180 mg/24 h). The tremor resolved completely with urosepsis resolution and magnesium repletion (Figure 3⇓).
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
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