Wednesday, 1 October 2014

ECG of the Week - 29th September 2014 - Interpretation

This week's ECG is from a 60 yr old male who presented with 3 days of vomiting & diarrhoea.
Past medical history of hypertension and mild chronic renal impairment.
Thanks to Dr Anand Senthi for sharing this ECG case.
Check out the comments from our original post here.



Click to enlarge
Rate:

  • ~90 bpm
Rhythm:

  • Regular
  • Sinus rhythm
    • P waves best seen in the inferior leads
    • P waves difficult to see in the precordial and high-lateral leads
Axis:

  • Normal
Intervals:

  • PR - Prolonged (~240ms)
  • QRS - Prolonged (120ms)
  • QT - ms (QTc Bazette 380-400 ms)
Segments:
  • Nil significant abnormality
Additional:
  • Not typical LBBB or RBBB morphology given QRS widening
  • Peaked T waves leads V2-6
Interpretation:



  • ECG Features suggestive of hyperkalaemia


What happened ?

The patient had an urgent VBG which showed a K+ of 8.0 mmol/L ! 
Therapy with calcium gluconate, nebulised salbutamol and insulin/dextrose was commenced. 

Following treatment the ECG was repeated as is shown below:

ECG Post Treatment of Hyperkalaemia
Click to enlarge

This ECG shows resolution of PR prolongation, QRS widening and T wave peaking seen on the first ECG.

References / Further Reading

Life in the Fast Lane


Textbook

  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.