m New page: {{NHJ| |mainauthor= '''A.A.M. Wilde, R.B.A. van den Brink''' |edition= 2005:11,428 }} Figure 1|thumb A46-year-old male was admitted to our emergency ...
metabolic acidosis with a pH of 7.08 and serum lactate
4 mmol/l. Acute renal failure was diagnosed as the
cause, due to a combination of forward failure, high
dose of furosemide, spironolactone, in addition to
colchicine and an nonsteriodal anti-inflammatory drug
(NSAID) prescribed because of the patient’s gout,
compounded by the metabolic acidosis. The ECG in
figure 1 is a classic example of the effects of hyperkalaemia:
resting potential is reduced, partially inactivating
the sodium channels, reducing the depolarising
current and slowing atrial, AV and ventricular
conduction. Flattening and finally disappearance of
the P wave and broadening of the QRS complex result.
Life-threatening ventricular tachyarrhythmias with a
sinusoidal appearance may ensue in severe cases. Just
minutes after the ECG in figure 1, the ECG in figure
2 demonstrated onset of ventricular tachycardia.
Emergency measures were undertaken to lower the
serum potassium (i.e. correction of acidosis, insulin
and glucose iv, and calcium levulate iv). The patient
survived this episode; the ECG in figure 3 was taken
two days later at which time the serum potassium was
normal. He died several months later of progressive
heart failure.
Revision as of 17:31, 8 October 2007
Author(s)
A.A.M. Wilde, R.B.A. van den Brink
NHJ edition:
2005:11,428
These Rhythm Puzzles have been published in the Netherlands Heart Journal and are reproduced here under the prevailing creative commons license with permission from the publisher, Bohn Stafleu Van Loghum.
The ECG can be enlarged twice by clicking on the image and it's first enlargement
Figure 1
A46-year-old male was admitted to our emergency
room with dyspnoea. His medical history included
congestive heart failure with a left ventricular ejection
fraction of under 10%, type II diabetes, gout, hypothyroidism
and morbid obesity. Physical examination
was severely hampered by the patient’s weight (in
excess of 230 kg), but revealed signs of right and left
heart failure. The ECG on admission is shown in
figure 1.
What diagnosis does it suggest, what further information do you need, and how should the patient be treated?
