A patient with chest pain and ST Elevation in V1 and V2
A 56 year old male complained of chest pain and called 911.They recorded a prehospital ECG:As you can see, at the top it says ***Meet ST Elevation MI Criteria***The medics activated the cath lab prehospital.It is a pathognomonic ECG.What is it?This is hyperkalemia, severe. Surprisingly, there appear to be P-waves, which are often extinguished when the K is so high.Severe hyperkalemia often presents with STE in V1 and V2, often with a Brugada-like morphology (tall R in V1, or rSR ' ; downsloping ST segment; negative T-wave. There is a very wide QRS and very peaked T-waves. Especially in V4 and V5, T-waves are peaked because of a narrow base, which is the result of a long flat ST segment (see especially lead III).Hyperkalemia often results in ST Elevation in V1 and V2 that mimics STEMI. This is a common pseudoSTEMI pattern! This link has many cases.On arrival, the hyperK was recognized and the cath lab was cancelled. The patient was a dialysis patient who missed dialysis the day before.An arrival ECG was recorded as treatment was started:QRS duration is 258 msIt is almost a sine wave.There are no definite P-waves, but that does not mean that the sinus node is not pacing. The sinus can still be pacing and conducting, but without any atrial activity to generate a P-wave. As Ken states below, this is known as asinoventricular rhythmSee here examples of sine wave.Another ECG was recorded 28 minutes later, after treatment with Calcium, ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Steve Smith Source Type: blogs
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