LBBB in Hyperkalæmia
Report:
Accelerated junctional rhythm 90 - 96/min
? Sinus rhythm with sino-ventricular conduction
Left bundle branch block
QRS 0.22â
Peaked T waves suggestive of hyperkalæmia
Comment:
The potassium rose to 8.0 mEq/L and probably higher.
The rhythm is uncertain; atrial paralysis in hyperkalæmia may have masked P (or other atrial) waves. Sinus P waves reappeared at potassium level 5.9 mEq/L the following day (Fig 2a) below); their amplitude was still small. The QRS duration is diminished to 0.16â and the T waves are less peaked.
Sinoventricular conduction is often thought of, but rarely documented.
Figure 2a. Reappearance of atrial waves, almost certainly sinus, the following day.
Fig 3. Postoperative ECG in a 27 year old man with replaced bicuspid aortic valve and repaired ascending aortic aneurysm.
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