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Arrhythmia Recognition Webcast Series
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Practice ECG 27
This ECG is tough to interpret until you find the pattern. Looking at the ECG as a whole, the T waves appear very pronounced. In most cases, the T waves are as tall as the R waves! This alone should point you in the direction of hyperkalemia. These peaked, broad T waves are classic for advanced hyperkalemia. The QRS complexes are wider than 0.12 seconds. However, the pattern does not fit either LBBB or RBBB. This mixed pattern is an IVCD, also very common in advanced hyperkalemia. The last tip-off is the lack of P waves, which also occurs in advanced hyperkalemia. This patient will die unless you act fast! Make the diagnosis and start the treatment simultaneously. If you do not understand these concepts, go back and review Chapter 16. This is one of the most easily missed diagnoses, and one that is potentially lethal.
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