TRIP

Weakness and Bradycardia

Dr Smith's ECG Blog, 2012

A 70 yo man with a h/o DM, HTN, CAD, chronic renal insufficiency and recent NonSTEMI with pulmonary edema who is on carvedilol and amlodipine called 911 for weakness.  His pulse was 40.  BP was about 100 systolic.
Bradycardia and large T-waves should immediately make you want to know the K.  The K was 6.8 mEq/L.  Creatinine was elevated at 5.0 mg/dl and the patient stated his urine output was low.  He also had melena and a low hemoglobin.  We placed a dialysis catheter and he went to the ICU for dialysis.  The next AM this ECG was recorded:
Comments not appropriate for general posting, or interesting ECGs, may be sent here (do this judiciously!) : .
If there are features that make LAD occlusion obvious (inferior or anterior ST depression, convexity, terminal QRS distortion), then the equation MAY NOT apply.
ST elevation (STE) is measured at 60 milliseconds after the J-point, relative to the PR segment, in millimeters .
(1.196 x STE at 60 ms after the J-point in V3 in mm) (0.059 x computerized QTc) - (0.326 x R-wave Amplitude in V4 in mm).
The blog is featured on Podcast 42 of , with an on various aspects of the ECG in MI, and another on left bundle branch block, with an .