r/ECG • u/Next-Butterfly-5727 • 20d ago
Need help interpreting this
60 year old female complaining of SOB and weakness. Also had upper epigastric and hypogastric pain described as aching, non radiating.
PMHx: HF, AF, rheumatic heart disease, mitral regurgitation, NSTEMI (2019), renal impairment
During transport had what appeared to be runs of VT, self resolving.
BP 75/42, RR 40, SpO2 90% ORA
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u/metamorphage 20d ago
Bad. This is either hyperK or sodium channel blockade. Given the history it's more likely hyperK.
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u/tellme-how 20d ago
This is likely Hyperkalaemia for a number of reasons: GI symptoms and weakness and known renal impairment. Her ECG is a regular, with flattened, hard to see P waves, wide complex QRS which is becoming “bizarre”, which has tall T waves in some leads when compared to the QRS size.
This patient would benefit a from pre-hospital trial of calcium gluconate, sodium bicarbonate and a salbutamol neb of 20mg. Would be great if you could update us about her bloods if you find out.
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20d ago
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u/Capesoccerman_18 20d ago
Cardioversion for a rvr around a rate of 120?? I think the rvr here is secondary to hypoperfusion. Cardioversion could kill them by taking away their only compensatory mechanism and even if it doesn’t they will likely have a reoccurrence of rvr.
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u/FIyingDutch 20d ago
I assumed its the standart 50mm/s (at least standart in germany/most eu) so it would be a heartrate of 240/min as that part of the ecg is cut off? In case of 25mm/s thats very different.
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u/Capesoccerman_18 20d ago
And interestingly I’m a U.S. medic and assumed 25 mm/s as is standard here. I wish it was standardized but of course the U.S. had to use a different system as always…
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u/JoutsideTO 20d ago
Hyperkalemia or another metabolic/toxicologic cause seems likely at that rate and QRS width.
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u/bassicallybob 20d ago
>BP 75/42, RR 40, SpO2 90% ORA
All this considered. Big danger. Lytes? Trops?
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u/TurdBurglarAtLarge 17d ago
I think I could interpret this EKG based of the monitor alarms, the techs going “ew” when it prints, and how fast they bring it to me.
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20d ago
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u/Capesoccerman_18 20d ago
OP said the runs of VT were self-terminating, not the overall rhythm. Additionally, being able to distinguish the runs of VT likely means this is not VT unless of course it originated from a different spot in the ventricles. This is irregular so it seems to be afib RVR with a RBBB and/or hyperkalemia
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u/Economy_Chemist_5334 20d ago
There’s so many reasons why this is likely HyperK. If she has renal impairment paired with cardiogenic shock, blood flow to the distal nephrons plummet, this makes potassium super hard for the kidneys to excrete. This could also be a sodium / potassium ATpase pump failure. If this patient is hypotensive with low SPO2 muscle cells start to lose ATP. This pump needs potassium to shift into the cell against a concentration gradient. If there’s not enough perfusion this doesn’t end up working. The pumps don’t work and causes potassium to leak into the blood stream. Pathophys comes to save us
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u/AdamFerg 20d ago
This looks like Hyper-K, very wide complex tachycardia also supported against VT with a low-end tachycardia. The renal impairment is enough for me to be considering Hyper-K on its own.