ECG Case 027

Elderly patient feeling generally unwell. PMHx of T2DM, hypertension, IHD, CCF, osteoarthritis. Describe the ECG.

TOP 100 ECG QUIZ LITFL 027 2

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Main Abnormalities

  • Bizarre appearing complexes.
  • Marked T wave peaking in V2-6.
  • Gross QRS prolongation (~200 ms).
  • Some leads (I, aVR) are starting to take on a sine wave appearance.

Diagnosis

The combination of…

  • Bizarre complexes
  • QRS prolongation
  • Peaked T waves
  • Sine wave appearance

… are all strongly suggestive of severe hyperkalemia.

This patient had a serum K of 9.2 mmol/L!

In this elderly patient with multiple medical problems, causes could include renal failure (e.g. due to diuretics, NSAIDs, intercurrent illness) or treatment with ACE-inhibitors, spironalactone or K-supplements.


TOP 100 ECG SERIES


Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

One comment

  1. What is the rhythm? Is it a 2:1 AT or sinus?

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