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ECG in severe hyperkalaemia: pacemaker doesn't matter so much
  1. Alberto Cecconi,
  2. Eduardo Franco Díez,
  3. José Juan Gómez de Diego,
  4. Iván Núñez Gil
  1. Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
  1. Correspondence to Dr Alberto Cecconi, Department of Cardiology, Hospital Clínico San Carlos, C/ Profesor Martín Lagos s/n, Madrid 28040, Spain; albertocecconi{at}hotmail.com.

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Case 1: A 51-year-old man with diabetes was referred for primary angioplasty with the working diagnosis of inferior ST elevation infarction. He denied chest pain but presented with severe diarrhoea in the previous days with obnubilation. ECG showed widened QRS complexes followed by peaked T waves with a shortened QT interval, P waves were not discernible (figure 1A). Blood analysis confirmed severe hyperkalaemia (K+ 9.4 mmol/L) due to acute renal failure (serum creatinine 15.7 mg/dL), without signs of ketoacidosis. Troponin I was normal. After infusion of calcium gluconate, higher heart rate and narrower QRS complexes were observed, …

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