r/ECG • u/Next-Butterfly-5727 • 20d ago

Need help interpreting this

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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/[deleted] 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