K > 5.5 mEq/L Peaked T waves (usually the earliest sign of hyperkalaemia)
K > 6.5 mEq/L P wave widens and flattens PR segment lengthens P waves eventually disappear
K > 7.0 mEq/L Wide QRS complexes with bizarre QRS morphology ST elevation High-grade AV block Any kind of conduction block (bundle branch blocks, fascicular blocks) Sinus bradycardia or slow AF Development of a sine wave appearance
K > 9.0 mEq/L Asystole Ventricular fibrillation PEA with bizarre, wide complex rhythm
ECG findings: • Low atrial rhythm • Markedly prolonged QT • Some PVCs are located on the T waves inducing non-sustained ventricular tachycardia. this is referred to as “R on T phenomenon” and explains the symptoms.
The patient underwent genetic testing and the congenital long QT syndrome was confirmed and she got a secondary prevention ICD.