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Challenges in Clinical Electrocardiography
November 13, 2017

ST Elevations in the Setting of Hyperkalemia

Author Affiliations
  • 1University of Tennessee Health Science Center, Memphis, Tennessee
JAMA Intern Med. Published online November 13, 2017. doi:10.1001/jamainternmed.2017.6329

A woman in her 50s with a history of hypertension, hyperlipidemia, diabetes, neuropathy, smoking, asthma, and previous stroke presented with altered mental status and respiratory distress necessitating intubation in the field. An electrocardiogram (ECG) was recorded on presentation (Figure 1). On arrival, she was found to have 1 episode of nonsustained ventricular tachycardia but otherwise remained in normal sinus rhythm. Home medications included lisinopril, amitriptyline hydrochloride, and insulin. On physical examination, she was nonresponsive, with blood pressure of 113/70 mm Hg and pulse of 59 beats per minute with 100% oxygen saturation with mechanical ventilation. Examination including the cardiovascular system had normal results.

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