Hyperkalemia in a patient with pacemaker

A 70 year old patient complaining of generalized swelling. 

This strip can can tell you 2 things: 

Image 1

-In V1 you can see the atrial spikes. This patient had an AICD. EF is in the 30's which could explain the low voltage ecg and poor R wave progression (cardiomyopathy).

-There is hyperkalemia as shown by a wide QRS and tall T waves in the precordial leads. (compare the 12L in the case and the 12L below when K was normal).

Image 2

The reason for the swelling was acute renal failure and the K was ~ 7.Calcium gluconate, glucose-insulin, sodium bicarb and kayexalate were given.

So, the 2 things that this strip can tell: cardiomyopathy - low voltage limb leads/poor R wave progression and hyperkalemia.

#115