Wide Complex QRS Tachycardia with hyperkalemia

Dr. Raimundo Barbosa Barros
Brazil

Case presentation

It is a Caucasian man of 62 years old, with coronary artery disease, type 2 diabetes mellitus and hypertension long time ago. He has previous history of acute myocardial infarction treated during emergency with stent placement and subsequent surgical revascularization. He was admitted with complaints of dizziness for 4 days, sweating and pallor (without syncope). He is using regularly amlodipine, aspirin, simvastatin, monocordil and insulin. BP = 170/90 mmHg; RCR = 130 bpm; hypophonetic sounds. The serum potassium level was very high (K + 9.3 mEq /l). Additionally, uremic picture was present (Blood Urea Nitrogen (BUN > 100mg/dl and Creatinine = 4,1mg/dl.).

ECG-1 revealing sustained complex wide QRS tachycardia Echocardiogram = normal contractility; FE = 52%.
ECG-2 performed immediately after reversion.
ECG-3: Basal ECG after dialytic treatment.

Question:

Which are the ECG diagnosis of the three ECGs and why?

Apresentação do caso

Trata-se de um homem de 62 anos, portador de doença arterial coronariana, diabetes Mellitus tipo 2, hipertensão arterial sistêmica e coronariano: História prévia de infarto agudo com colocação de stent e posterior revascularização cirúrgica.
Deu entrada com queixa de tonturas há 4 dias com sudorese e palidez (sem síncope). Faz uso regular de anlodipino, AAS, sinvastatina, monocordil e insulina. PA=170/90; RCR FC 130mbm bulhas hipofonéticas. K+ 9,3 mEq/L; Ureia > 150mg/dL; creatinina = 4,1 mg/dL). ECG-1 que revela taquicardia sustentada de QRS largo

Ecocardiograma =contratilidade normal; FE= 52%. ECG-2 realizado imediatamente após a reversão.
O ECG3 de base após as medidas e hemodiálise.