What Does This T-Wave Pattern Indicate?

K. Wang, MD

Disclosures

June 16, 2014

Discussion

The T waves are not particularly prominent, but the bases of the T waves quickly become narrow. The T waves are tented, as if pinched from above, especially in leads V2 and V3, and are diagnostic of hyperkalemia. The patient's serum potassium level was 6.8 mEq/L at the time (normal range for adults is approximately 3.5-5.5 mEq/L).

The T waves do not have to be tall or prominent; having the "tented" shape suggestive of being pinched from above is more important for the ECG manifestations of hyperkalemia. Sometimes the findings are seen only in a single lead.[1,2] The ST segments are "scooped out" in some leads, suggesting the pharmacologic effects of digitalis, but this merely indicates that the patient is taking digoxin; it is not a sign of digitalis toxicity. Hyperacute T-wave changes are not tented or pinched from above, and the upstrokes and downstrokes are straight, not curved.[1,2]

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