This ECG is from a 57-year-old woman with extreme weakness. We do not know her medical history or complete lab results, except that her serum potassium level was 8.8 mEq/liter at the time of this ECG.
This ECG was taken from an elderly man who was in acute renal failure, and had presented to the Emergency Department via EMS. He was weak and hypotensive. We have no other medical history or clinical information.
This strip offers several good teaching opportunities. If it were a 12-lead ECG, no doubt it would be a bonanza! First, there is sinus tachycardia at a rate of about 138 per minute. The P waves are all alike and regular. The T waves are tall and narrow, with a sharp peak. This is often a transient sign of hyperkalemia, and should be investigated with serum electrolyte tests and with a 12-lead ECG. In addition, the baseline shows a wandering type of artifact.
This ECG was obtained from a patient who had a serum potassium level of 7.4 mEq/L. It shows some of the earliest ECG signs of hyperkalemia. There are tall, sharply-peaked T waves in many leads. The P waves have not yet widened and lost amplitude, but they will soon flatten out and disappear.
This ECG was obtained from a patient who was suffering from renal failure and had a serum potassium level of 6.8 mEq/L. It shows some of the earliest ECG signs of hyperkalemia. There are tall, sharply-peaked T waves in many leads. There is an irregular, bradycardic rhythm. We can just barely see P waves, but they will soon flatten out and disappear. At this level of hyperkalemia, we can expect to see conduction disturbances and bradycardia. Caution: hyperkalemia can progress and become life-threatening very quickly.
For your collection, we present another interesting set of ECGs from Paramedic Erik Testerman. They are from a 48 year old man who presented responsive only to painful stimuli, with deep, rapid (Kussmaul's) respirations. His blood glucose in the field read as "HIGH" - too high for the glucometer to register a number. He was treated with 3 large-bore IVs, 2 liters of NSS IV, O2. At the hospital, his blood glucose again registered as "HIGH" on the glucometer, arterial O2 was 90%, CO2 15 (low), pH 6.8 (acidotic), HCO3 -2 (depleted).
This ECG was kindly donated to the ECG Guru website by Dr. Ahmed for open discussion among our members. The patient was a 70+ year-old man who presented with a complaint of dizziness. His serum potassium level was found to be 6.5 (normal is 3.5 - 5.0). Upon correction of his K levels, his rhythm was atrial fibrillation at 130 / min.
WHAT DO YOU THINK ABOUT THIS INITIAL ECG? What is causing the slow rate? Is there atrial activity? Do you see QRS morphology changes? What about the anterior ST and T wave changes?
Patient's clinical data: 87-year-old black man
(1.) What is this 12-lead ECG suggestive of?
(2.) What are some other differential diagnoses?
This week’s ECG is categorized under the heading:“Tracing suggestive of ” This is a classical example of this pair of derangements.
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