This post is an answer to the ECG Case 342
- Rate: ventricular rate ~16 bpm
- Rhythm:
- Irregular ventricular complexes
- No p waves visible
- Axis: left axis deviation
- Intervals:
- QRS – Significantly Prolonged (>320ms)
- Additional:
- Loss of normal QRS morphology
- Bizarre notches QRS complexes in leads V2-5
- Discordant ST / T wave changes
Interpretation
- Near sine wave appearance
- Severe bradycardia
- Atrial standstill / atrial fibrillation
- Peri-arrest rhythm
Differentials for this appearance include:
- Hyperkalaemia
- Sodium channel toxicity – esp TCA overdose
- Medications digoxin, beta-blocker, calcium channel blocker
- Hypothermia
What happened next ?
The patient had a normal core temperature and was not taking any potential culprit medications. His potassium was 8.7 mmol/L in the setting of acute severe renal failure. His ECG normalised following emergent potassium correction and he was transferred to critical care for dialysis and further management of his acute electrolyte abnormality.
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