Monday, February 6, 2012

Weakness and Bradycardia

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.

Here is his prehospital ECG:

There is sinus bradycardia with Giant T-waves. 





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:
Normal sinus rhythm and normal T-waves.

Learning point: Bradycardia should always make you think of hyperkalemia.

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