EKG of the Week 2016 12-11

This EKG comes courtesy of Dr. Shant Broukian.

A 68-year-old male with PMH significant for atrial fibrillation status post 3 ablations, diabetes, hypertension, peripheral vascular disease status post left BKA, presented to the ED for shortness of breath over the last several days but which acutely worsened over the last several hours.

His EKG is below.

1.     What diagnosis is suggested by the EKG?

 

2.     How would you manage this patient?

 

ANSWER:

The EKG represents hyperkalemia.

The management is IV Calcium.

 

The EKG shows a wide QRS complex rhythm at a rate of 65. There are no P waves. This can represent an accelerated idioventricular rhythm. However, whenever you see something that looks like “slow V-tach” think about hyperkalemia. This patient had a potassium level of 9.3.

Hyperkalemia causes a series of EKG changes beginning with peaking of the T waves followed by widening of the QRS complex and ultimately a sine wave morphology.

Patients with hyperkalemia showing significant EKG changes should be treated with IV calcium. The calcium does not affect the Potassium level, but rather it stabilizes the heart against the negative affects of hyperkalemia. Treatment with calcium should result in narrowing of the QRS complex within minutes of administration. Below is this patient’s EKG after calcium administration.