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All ECG 32

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Source: Learn the Heart

There are P waves visible in the lead II rhythm strip; the atrial rate is in the high 30s per minute and there is no relationship between the P waves and the QRS complexes (ie, complete heart block). The QRS morphology is unlike anything normally seen. The QRS is concordant upward — all directed upward — in the precordial leads. This meets one of the Brugada criteria for a ventricular rhythm and is consistent with an idioventricular rhythm. 

This ECG was recorded when the patient’s serum potassium level was 8.2 mEq/L. A “sine wave” pattern subsequently developed; thus, these ECG changes were precursors to the classic “sine wave” of hyperkalemia.

A detailed review of the ECG changes with hyperkalemia can be found in the relevant link below.

Related: Sinus Bradycardia ECG Review, Third-Degree Atrioventricular (AV) Block ECG Review, Hyperkalemia ECG Review