Case 62: A 71-Year-Old Man in the Emergency Department
History
Diagnosis
ECG 2
ECG 2 Diagnosis
ECG 3
ECG 3 Diagnosis
History
A 71-year-old man with end-stage renal disease on hemodialysis presents to the emergency department with weakness and malaise. He reports that he was recently treated with antibiotics for a febrile illness of unkown etiology:
Diagnosis
- No P waves are seen
- Wide QRS rhythm, 74/min – QRS duration 160 msec
- Right bundle branch block
- Suspect hyperkalemia
The serum potassium was > 8 mmol/L (normal = 3.5 – 5.0)
ECG 2
The patient is rapidly started on hemodialysis, and the following ECG is recorded: 
ECG 2 Diagnosis
- P waves are not seen – Narrow QRS tachycardia, 101/min
- Right bundle branch block
- Tall peaked T waves in I, II, V2-V6
These findings reflect evolutionary ECG changes following treatment of severe hyperkalemia.
ECG 3
The following ECG is recorded an hour later:
ECG 3 Diagnosis
- Sinus rhythm, 73/min
- QRS duration 80 msec
- Normal ECG
The patient’s symptoms rapidly improved, and he was discharged from hospital on the following day.
ECG ID: E576