|See description and answer below|
Hint: this is a dialysis patient
1. There are peaked T-waves
2. There is a long ST segment, resulting in a long QTc (490 ms). See the ST segments in inferior and lateral leads especially.
Diagnosis: hyperkalemia (6.0 mEq/L) + hypocalcemia (causing long ST segment) (ionized Ca = 3.41 mEq/L)
Here is the patient's ECG when the K = 4.1 and the Calcium is also low:
|ST segments and QT are long (hypocalcemia), but the T-waves are not peaked.|