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Think of hyperkalemia in cases of strange or bizarre brady & tachycardias! Dealing with a bizarre ECG? Think HyperK!
Hyperkalemia is known to cause a variety of ECG changes, it can do whatever it wants to the ECG!
Hyperkalemia can produce abrupt changes in rhythm
Bradyarrhythmia (wide & narrow) are common in the setting of hyperkalemia
ACLS often does not work in cases of unstable bradycardia from hyperkalemia!
Atropine, pacers, & pressors are unreliable in treating hyperkalemic bradycardia
Strongly consider hyperkalemia in bradyarrhythmia refractory to ACLS
Hyperkalemia may also cause really wide complex tachycardias (RRWCT, QRS > 200 ms)
May mimic VT (antiarrhytmics may be deadly)
Consider empiric treatment with calcium and sodium bicarbonate
Maintain a high index of suspicion and consider hyperkalemia when dealing with any "bizarre" rhythm.
Consider some of the following ECG findings in Hyperkalemia:
Peaked T-waves (even when inverted)
Widening of the QRS (often marked)
Prolonged PR-interval
Flattening and eventual loss of P-waves
Tachydysrhythmias, pseudo ventricular tachycardia
Bizarre bradydysrhythmias, advanced AV Blocks and sinus pauses
Axis changes (especially RAD)
Fascicular & Bundle Branch Blocks
ST-segment changes (can mimic ACS)
Pseudo Brugada pattern
Sine wave morphology, asystole
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