She has a history of aortic and mitral valve replacements, AF, CABG, COPD and prior CVA. This is her ECG.
What's going on?
There is slow AF, a LBBB pattern and abnormal repolarisation. Given her extensive cardiac history, most of these findings are not unexpected...
However, this is hyperkalaemia (K = 8.9) on the background of an already abnormal ECG. There is a slow rate, widening of the QRS, and prominent T waves throughout, with a biphasic appearance when compared with previous and post-treatment ECGs.
This is her ECG the following morning with a normal potassium, showing resolution of the changes.
For baseline, this is her previous ECG (10 years ago!) that was not available for comparison with the initial one.
Lesson learnt from this case - always check the potassium when the ECG is bizarre.
Personal details altered for confidentiality.