Hyperkalemia: is it the cause of this AV Block, ST Elevation, and T-wave inversion?

I was texted this ECG:What do you think?This was my response: " Yikes. Pacer and Cath Lab!! "He asked: " Could this all be due to hyperK? "I said: " Always possible. But it does not look like it.  Among the reasons I do not think it is all due to potassium is that the QRS is not wide. "  Also, there are obvious signs of OMI, and though these can sometimes be mimicked by hyperkalemia, the K must bevery high.ECG analysis:Sinus tachycardia with third degree AV block and a junctional escape.  QRS is 100 ms.  There areinferior Q-waves with inferior ST Elevation of OMI, and T-wave inversion, suggesting reperfusion or subacute OMI.  The inverted T-waves are large, which is evidence of significant viable myocardium.  The lead reciprocal to lead III is aVL, and there is the obligatory reciprocal ST depression, but also areciprocally large upright T-wave(a mirror image to the inferior inverted (reperfusion) T-wave.  There is also STD in V2 and V3, with large upright T-waves indicatingreperfusion of theposterior wall.  There is STE of OMI in V5 and V6, with terminal T-wave inversion, also suggestive of subacute or reperfusinglateral OMI.The tall upright T-waves in aVL and V3 might conjure up hyperK in your mind, but these T-waves are reciprocal to large inverted reperfusion T-waves: aVL reciprocal to III, and V3 is a posterior reperfusion T-wave, reciprocal to an imaginary inverted T-wave of the posterior wall.  See m...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs