This lady in her 60s was brought to ED after a conscious collapse, in which she describes chest heaviness and leg weakness, falling to the ground. No loss of consciousness, felt dizzy afterwards.
She has a history of aortic and mitral valve replacements, AF, CABG, COPD and prior CVA. This is her ECG.
There is slow AF, a LBBB pattern and abnormal repolarisation. Given her extensive cardiac history, most of these findings are not unexpected...
However, this is hyperkalaemia (K = 8.9) on the background of an already abnormal ECG. There is a slow rate, widening of the QRS, and prominent T waves throughout, with a biphasic appearance when compared with previous and post-treatment ECGs.
This is her ECG the following morning with a normal potassium, showing resolution of the changes.
Image may be NSFW. Clik here to view.
For baseline, this is her previous ECG (10 years ago!) that was not available for comparison with the initial one.
Image may be NSFW. Clik here to view.
Lesson learnt from this case - always check the potassium when the ECG is bizarre.
