This tracing is from 40 yo pt with h/o HTN, DM,
CHF and end stage renal disease c/o of pleuritic chest pain and cough.
Figure 1 - ECG case
What is the ECG interpretation?
The tracing shows an irregular narrow complex
tachycardia with P waves of different morphologies (multifocal atrial
tachycardia), peaked T waves in the precordial leads (esp in V3 and
V4)suggestive of hyperkalemia and tall R waves in V6 and deep S in V2 (suggestive
of LVH).
Lab investigation showed Hb 10, WBC - 7, PC - 200,
Trop -0.2, K 8, Creatinine - 20 and CXR showed cardiomegaly and congestive
heart failure worst compared to a prior study.
The case was managed as critical hyperkalemia
(K-8.0). Calcium gluconate, NaHCO3, glucose-insulin was given and dialysis was
eventually done. The chest pain was thought to be due to non-ischemic in nature
(had a recent normal angiogram). The troponin elevation was attributed to the
chronic kidney disease. Eventually discharged after a few days.
#443
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