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This is a 68 year old female with left sided pressure like, nonradiating chest pain. She has not seen a doctor in 20 years.
Rate: 78
Rhythm: regular
Axis: normal, but borderline
PR: no p waves present
QRS: wide
ST: t wave inversion in II, III, aVF and peak t waves in V2-V4
EKG diagnosis: Idioventricular rhythm, with inferior ischemia, Probable hyperkalemia
Clinical diagnosis: (Give a description to the progression of this EKG secondary to its cause)
- · Chest pain r/o MI, consider inferior ischemia and idioventricular rhythm secondary to hyperkalemia
- · Progression of hyperkalemia on the EKG:
- · K= 5.5-6.5 meq/L -tall peaked t waves, QT shortening
- · K= 6.5-7.5 meq/L
- · First degree AV block
- · QRS widening
- · Flattening and widening of the P wave
- · K> 7.5 meq/L
- · -disappearance of the p wave—due to sinus arrest or sinoventricular conduction
- · -LBBB, RBBB, sine-wave pattern
- · -ST elevation
- · -Arrhythmias and conduction disturbances including V. Tach, V. Fib, idioventricular rhythm, or asystole
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