Peaked T waves
This strip offers several good teaching opportunities. If it were a 12-lead ECG, no doubt it would be a bonanza! First, there is sinus tachycardia at a rate of about 138 per minute. The P waves are all alike and regular. The T waves are tall and narrow, with a sharp peak. This is often a transient sign of hyperkalemia, and should be investigated with serum electrolyte tests and with a 12-lead ECG. In addition, the baseline shows a wandering type of artifact.
This ECG was obtained from a patient who was suffering from renal failure and had a serum potassium level of 6.8 mEq/L. It shows some of the earliest ECG signs of hyperkalemia. There are tall, sharply-peaked T waves in many leads. There is an irregular, bradycardic rhythm. We can just barely see P waves, but they will soon flatten out and disappear. At this level of hyperkalemia, we can expect to see conduction disturbances and bradycardia. Caution: hyperkalemia can progress and become life-threatening very quickly.
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