Patient with Dyspnea. You are handed a triage ECG interpreted as " normal " by the computer.

I was handed this ECG of a patient with dyspnea:What do you think?Computer interpretation: Normal EKGPhysician Overread (Final interpretation): Normal EKGThe ST segment is very flat, with a sudden rise to the peak of the T-wave.  This makes the base of the T-wave look very narrow.  A narrow-based T-wave is nearly pathognomonic for hyperkalemia.  My diagnosis was hyperkalemia.The resident I showed it to saw nothing.  I explained all this to the resident, then went to see the patient.Turns out he is a dialysis patient.Later, the ECG computer interpretation was overread by another physician, and that physician thought it was normal, but took the step to compare with the most recent previous ECG.  There was no change, so that physician concluded that it was indeed normal and entered " Normal EKG " as the final diagnosis.However, I looked a bit more in depth, and the previous ECG had also been recorded during hyperkalemia.The K returned at 6.3 mEq/L.Let ' s look at a couple previous ones from 2 years prior:This was recorded when this patient presented with diaphoresis and muscle cramps:The formal read was normal except for " possible old lateral MI "QTc was measured at 484 ms which appears to be accurate, but the statement did not say " long QT "There are definitely peaked T waves, and a long flat ST segment with an abrupt rise to the peak of the T-waves.The K was 6.6 mEq/LWhat else do you suspect?This ECG was recorded a few hours later after bringing down...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs