What are these ST elevations, ST depressions, and tall T waves diagnostic of?

 Written by Pendell MeyersLet ' s see this presentation ECG without any context first (no baseline ECG was available)What do you think? What will you do?The ECG is diagnostic of severe hyperkalemia. There is sinus tachycardia, the beginning of QRS widening, tall pointy peaked T waves with little area compared to their height. There is STE in V1-V3, aVR, and aVL, with STD in II, III, aVF, V4-V6. The appearance in V1 is similar to the Brugada morphology (as is often the case in hyperkalemia and Na channel blocker effects causing STE). Together these ST elevations in the right precordial leads and aVL are classic pseudoSTEMI (or pseudoOMI) patterns seen in hyperkalemia (see the end of the post for links to many similar cases). This ECG shows no evidence of OMI despite the fact that it meets STEMI criteria - it is all hyperK. Of course there may also be an additional component of acidosis, peri-ROSC, etc, given the context below, but hyperkalemia is the most contributory factor.This was a man in his 30s who was found down and altered. He was seen normal the day before, then found in his bed by a friend, unresponsive. CPR was administered. EMS arrived and found him in PEA arrest. He was given epinephrine, calcium, and bicarbonate, and after several rounds of CPR he was found to have a pulse. He was intubated in the field. He was tachycardic and hypotensive. EMS recorded this ECG above just before arriving to the ED.When the ED provider saw this ECG, they activated the cath la...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs