EKG of the Week

EKG of the week 4_Page_1.jpg

This is a 77 year old man with history of CAD, HTN, and CKD who presented with 2-3 day hx vomiting, weakness, lethargy, and pre-syncopal episodes.

+ EKG Interpretation

Dr. Ohlbaum's Explanation

This is a tough EKG especially because it needs to be recognized and treated very quickly.

Hint: The numbers on the page for rate and QRS duration that you see are my corrections. The computer thought the rate was 115. Why would the computer have thought that?? Do you think the computer is getting confused and calling the T wave another QRS? It is big and duration about the same as the QRS duration.

Let’s look at the EKG. The rhythm is irregular, and fairly slow (around 60). I can’t convince myself there are P waves. The QRS is really, really wide (>250 msecs). Could be afib but that would not explain the really wide QRS. A ventricular rhythm would usually be regular.

So now we have noticed slow, irreg rhythm, no definable P wave, very wide QRS, big T wave. What do you think?

This is pretty typical for severe hyperkalemia. The patient was in renal failure (his k went from baseline 1.9 to 7) with a K of nearly 9 (ok... 8.8). The patient was given bicarb, calcium, glucose, insulin, albuterol inhalers while being set up for emergent dialysis. He had a brief period of “sine wave” during that time but responded to treatment, was dialyzed and did well. His kidney function returned to baseline over a few days and he was able to return home.

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