ECG in severe hyperkalaemia: pacemaker doesn't matter so much

Case 1: A 51-year-old man with diabetes was referred for primary angioplasty with the working diagnosis of inferior ST elevation infarction. He denied chest pain but presented with severe diarrhoea in the previous days with obnubilation. ECG showed widened QRS complexes followed by peaked T waves with a shortened QT interval, P waves were not discernible (figure 1A). Blood analysis confirmed severe hyperkalaemia (K+ 9.4 mmol/L) due to acute renal failure (serum creatinine 15.7 mg/dL), without signs of ketoacidosis. Troponin I was normal. After infusion of calcium gluconate, higher heart rate and narrower QRS complexes were observed, whereas P waves were sill unnoticeable (figure 1B). Figure 1ECG of a spontaneous rhythm. During severe hyperkalaemia (A), after calcium gluconate administration (B) and after serum potassium normalisation (C). Case 2: An 80-year-old woman was admitted for pacemaker lead infection treatment. Spironolactone was started...

Source: Heart Asia - March 18, 2014 Category: Cardiology Authors: Cecconi, A., Franco Diez, E., Gomez de Diego, J. J., Nunez Gil, I. Tags: Images in cardiovascular medicine Source Type: research