ECG Library


Expert ECG 7

  1. Sinus bradycardia
  2. 3rd degree AV block
  3. Ventricular escape
  4. Hyperkalemia

This is quite an unusal ECG. The QRS morphology is unlike anything normally seen. Since it is upward concordent (all directed upward) in the precordial leads, which is one of the Brugada criteria for a ventricular rhythm, a ventricular origin is suspected. This ECG occured in the setting of a potassium level of 8.2 which is very high. A "sine wave" pattern subsequently ensued, thus this ECG change was a precursor to the classic "sine wave" of hyperkalemia. Click the button below for a detaled review of the ECG changes of hyperkalemia. Also to be noted, in the setting of a ventricular rhythm, ischemia is difficult to diagnose. This ECG has ST elevation in the inferior leads with reciprocal depression suspicious for an inferior myocardial infarction, however that was not the case in this scenario. Note that there are no Q waves in the inferior leads that likely would be present in the setting of such an extensive myocardial infarction

Related Topic Reviews: Sinus Bradycardia, 3rd Degree AV Block, Hyperkalemia ECG