#Peaked t waves in hyperkalemia serial#

Below follows a discussion which aims to clarify some of the common misunderstandings. T-wave changes are notoriously misinterpreted, particularly inverted T-waves. Discordance and concordance between QRS and ST-T. A negative T-wave is also called an inverted T-wave. Otherwise there is discordance (opposite directions of QRS and T) which might be due to pathology. The T-wave should be concordant with the QRS complex, meaning that a net positive QRS complex should be followed by a positive T-wave, and vice versa ( Figure 17). Women have a more symmetrical T-wave, a more distinct transition from ST segment to T-wave and lower T-wave amplitude. The T-wave is normally slightly asymmetric since its downslope (second half) is steeper than its upslope (first half). As noted above, the transition from the ST segment to the T-wave should be smooth. The amplitude diminishes with increasing age. The T-wave amplitude is highest in V2–V3. The normal T-wave in adults is positive in most precordial and limb leads. aVL: true + vs.Assessment of the T-wave represents a difficult but fundamental part of ECG interpretation.Atrial Repolarization Wave with Additional Ischemic ST Depression (1).Atrial fibrillation-conversion to sinus (1).atrial fibrillation with slow ventricular response (1).Atrial Fibrillation with RVR exaggerates ST Elevation (1).atrial fibrillation with RVR - primary instability (1).Atrial Fibrillation RVR due to Secondary condition (2).Arrhythmogenic Right ventricular dysplasia (2).Arrhythmogenic Right Ventricular Cardiomyopathy (3).Appropriate Discordance in LBBB and Paced Rhythm (1).Antiplatelet Therapy for UA/NonSTEMI (1).Anti-dysrhythmics in STEMI w cardiac arrest/ventricular fibrillation (1).Anterior STEMI with minimal ST elevation less than 1 mm (11).Angiography in ROSC shockable rhythms (1).10 cases examples of lateral hyperacute T-waves V4-V6 (2).New Paper published on Significance of Reciprocal.STE in aVR and diffuse ST depression: It can be AC.What is the treatment for this subendocardial isch.Validation of Smith Modified Sgarbossa Criteria Pu.Very young man with chest pain, then cardiac arrest.Chest Pain, ST Elevation, and an Elevated Troponin.Here the potassium was barely high enough to result in a change in T-waves, so one should be especially suspicious in this case. Hyperacute T-waves and hyperkalemia may be confused, and they may be simultaneous. I mention this only to point out that these findings can be noticed, and differentiated from more benign etiologies, prospectively. I noticed it much later on looking through a random stack of EKGs. The possibility of anterior STEMI was not noticed during patient care. Had it not opened on its own, it could have resulted in a very large anterior wall MI. Therefore, she underwent angiography and had a 95% LAD thrombotic culprit that, fortunately, had reperfused on its own (that's why the troponin was only 12). Here is her ECG the next day (with a normal K):īecause of the high troponin, echocardiography was done and showed a wall motion abnormality in the anterior, anterolateral, and apical walls, consistent with LAD myocardial infarction.

#Peaked t waves in hyperkalemia serial#

The patient did have a serial troponins (they are automatically ordered on critically ill patients) and they rose to a peak of 12.4 ng/ml, which is too high for a typical critical illness without MI.

One would not expect such profound T-wave changes from a K of only 5.5. There is an S-wave in V3 now, although small. T-waves are much more normal, less peaked, but also with better R-wave amplitude. Her T-waves were attributed to hyperkalemia, without further investigation. The patient was in DKA with an anion gap of 35, a glucose of 1128, and a K of 5.5 mEq/L. The above is what I thought when I saw this, so I went to the chart and found this history:Ī type I diabetic aged approximately 35 years old presented with chest pain, nausea, vomiting and diffuse abdominal pain.

The formula score is 24.8 (>23.4), also consistent with anterior injury. These are suspicious for hyperacute T-waves and anterior injury. And there is terminal QRS distortion in lead V3 (meaning there is neither a J-wave nor an S-wave). But what is atypical is that the T-wave in V3 towers over the R-wave. The T-waves are slightly peaked, suggesting hyperkalemia. I saw this as I was reading a large a stack of ECGs: