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This post is an answer to the ECG Case 275

• Rate: 66 bpm
• Rhythm:
  • Regular
  • No P waves present
  • Accelerated Idioventricular Rhythm (AIVR)
• Axis: Normal
• Intervals: QRS – Prolonged (160ms)
• Segments:
  • Discordant ST segment changes
  • Excessive depression in lead V5 and excessive elevation V3 (just on -0.25 ST elevation / QRS depth)

• Additional:
  • LBBB Morphology
    • Deep S in V1-3
    • Broad R wave in lateral leads
  • T waves massively disproportionate and peaked
  • Note in leads V5-6 terminal portion of T wave becomes positive

The key abnormalities on this ECG are:

• AIVR
• LBBB with abnormal ST changes
• Massive peaked T waves

Broad differentials would include:

• Ischaemia
• Drug toxicity
• Acid-base disturbance
• Electrolyte abnormality

The diagnosis was hyperkalemia, urgent VBG was taken – K 8.8 mmol/L !

SIMILAR CASES:

• ECG Case 190: Hyperkalemia
• ECG Case 174: Hyperkalemia (Sine-Wave Pattern)
• Hyperkalemia and Hypocalcemia on ECG