What Is This Life-Threatening Condition?

Kyuhyun Wang, MD

Disclosures

August 14, 2013

Answer

Discussion

The rhythm is sinus, which speeds up slightly during the second to fourth beats from the end. The QRS complexes are wide even for the right bundle branch block, which is present. The PR interval is long. More specifically, T waves are tall, tented, and pointed, especially in V4. These findings are all characteristic of hyperkalemia. The serum potassium was 7.4 mEq at the time. In the rhythm strip V1, the second and third QRS complexes are narrower than others. This may be due to the slightly longer R1-R2 interval, which improved the intraventricular conduction transiently.

The rhythm is sinus all along, with the same prolonged PR interval -- not accelerated idioventricular rhythm. In the third and fourth beats from the end when the sinus rate slightly speeds up, the P wave is hidden within the ST segment. In any case, accelerated idioventricular rhythm is not life-threatening.

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