Middle-aged diabetic patient presenting with shortness of breath. Clinical evidence of pulmonary oedema.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
Main Abnormal Findings
- Severe bradycardia of 36 bpm.
- Rhythm is difficult to ascertain — appears irregular (?slow AF) although there are some small-voltage P waves seen in V1-2.
- Broad QRS complexes with an atypical LBBB morphology.
- Subtle symmetrical peaking (“tenting”) of the T waves in V2-5.
The combination of bradycardia, flattening and loss of P waves, QRS broadening and T wave abnormalities is highly suspicious for severe hyperkalaemia. This patient had a potassium of 8.0 in the context of anuric renal failure.
When you see the combination of…
- Blocks — e.g. AV block, bundle branch blocks
- Bizarre QRS complexes
…. think hyperkalaemia!