Case Study: Hyperkalemia and ECG Changes

Case Presentation

A 70-year-old male presented to the ER with giddiness & presyncope for the past two hours. He was also having difficulty in breathing. No other history was known, except that he was diabetic.

The first ECG:
first ecg - V

The second ECG after a few minutes:
second ecg - V

ECG showed a lack of P waves, suggesting junctional rhythm, slight widening of QRS and tall T waves with a narrow base (especially in the first ECG), producing an “Eiffel Tower” appearance.

The patient was referred for pacing, considering sick sinus syndrome. At first impression, due to bradycardia, he seems to be in need of temporary pacing.

Further blood investigations revealed electrolytes K: 7.9 and creatinine of 3.0. Immediately, K correction was started. After K correction, the ventricular rate increased.

ECG After K Correction:
ecg after k correction - V


In any patient presenting with symptomatic bradyarrhythmias, always rule out reversible causes first. Correction and treatment of these reversible causes may avoid the need for permanent pacing. Hyperkalemia is not an uncommon cause of symptomatic bradyarrhythmias and is ...

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