Hyperkalæmia: Sine Curve Tachycardia

Report:

First-second strips:

Broad-complex rhythms of uncertain origin

Third-fourth strips:

‘Sine curve’ tachycardia

Fifth-sixth strips:

Broad-complex tachycardia

Movement, probably CPR, artefact

Seventh strip (30 minutes since the top strip):

Sinus tachycardia

Intraventricular conduction defect

Eight (bottom) strip – K+ 4.6mEq/L:

Sinus tachycardia

VEBs

Comment:

The bottom strip was obtained four hours after the onset of resuscitation.

This is one of the best examples of the ‘sine curve’ morphology produced by merging of T waves with broad QRS complexes in hyperkalæmia. It looks like a sluggish (fat and relatively slow) variety of ventricular flutter.

The patient died, eventually, after a week of regular hæmodialysis, from sepsis. Patients no longer die from acute renal failure, although mortality is still around 50%; they die with it. The same can be said for ARDS.

98. A 77 year old man with myelofibrosis and pyrexia of unknown origin becoming septic shock. How many ectopic beats are in evidence?