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Eventually, merger of QRS complex and T wave will lead to the appearance of a typical sine-wave pattern. Contrary to our patient, a sine-wave pattern often precedes ventricular fibrillation or asystole. 2 Furthermore, rapidly progressing flaccid motor weakness may result in a quadriplegia, which was the presenting symptom in this case and is an ...

This is the “sine wave” rhythm of extreme hyperkalemia. This pattern usually appears when the serum potassium levels are well over 8.0 mEq/L. Had we seen the earlier ECGs, we might have had more warning, because the ECG in earlier stages of hyperkalemia shows us distinctive peaked, sharp T waves and a progressive intraventricular conduction ...

The sine wave pattern is one of the manifestations of severe hyperkalemia. The sine wave pattern depicts worsening cardiac conduction delay caused by the elevated level of extracellular potassium . The morphology of this sinusoidal pattern on ECG results from the fusion of wide QRS complexes with T waves .

ECG in severe hyperkalemia (Potassium >7,5 mmol/L) Previously mentioned ECG changes become more pronounced. The QRS complex becomes wider. Refer to Figure 1. If the hyperkalemia is very severe, the QRS complex may fuse with the T-wave and form a so-called sine wave. This is certainly alarming because sine wave pattern usually precedes ...

4. Development of a sine wave pattern. As K + levels rise further, the situation is becoming critical. The combination of broadening QRS complexes and tall T waves produces a sine wave pattern on the ECG readout. Cardiovascular collapse and death are imminent. 5. Endgame. Ventricular fibrillation

The ECG shows there is a regular rhythm with a rate of 100 bpm. There are no P waves seen before or after any QRS complexes. The QRS complex duration is very prolonged (↔) (0.28 sec). The QT/QTc intervals are prolonged (520/670 msec) but they are normal when the widened QRS complex duration is considered (360/460 msec).

Identification of Sine Wave in Early Suspicion of Hyperkalemia. Brian G Cornelius. ... (ECG) showed a wide complex idioventricular rhythm . He was then presumptively treated for hyperkalemia with calcium gluconate, insulin-dextrose infusion, bicarbonate, and albuterol nebulizations. We obtained serial ECGs, on which the QRS was noted to ...

Sine wave appearance (pre-terminal rhythm) Endgame: Ventricular fibrillation; Always consider the diagnosis of hyperkalemia in a patient with a history of dialysis, renal failure, or treatment with drugs like ACE inhibitors, ARBs, spironolactone especially if the ECG shows bradycardia or complete heart block.

Identification of a short PR interval and a delta wave on the ECG only confirms the presence of a WPW pattern. ... (> 8.0-9.0 mmol/L) may precipitate development of a sine wave appearance (pre-terminal rhythm); ventricular fibrillation; PEA with bizarre, wide complex rhythm; and eventually asystole. ...

One of the most recognizable signs of hyperkalemia is tall, peaked T waves, especially in precordial leads. As potassium levels increase, QRS complexes widen and may merge with T waves, forming a sine wave pattern. This pattern is a red flag for impending ventricular fibrillation [1] [2]. Why This Matters Clinically

This is a very wide complex tachycardia with a sine wave morphology at a rate of about 160 and a QRS duration of about 220 ms. Hyperkalemia by itself can have exactly this morphology (sine wave), but should not be so fast.On the other hand, ventricular tachycardia is fast but rarely has such a sine wave morphology with such a super wide QRS.

This article (10.1056/NEJMicm1113009) was updated on October 4, 2012, at NEJM.org.

This article is an answer to the ECG Case 174. The ECG shows a regular rhythm at a rate of 90 bpm. There are no P waves seen in any of the leads. The QRS complex is very wide (0.24 sec), best established by measuring the QRS complex duration in lead V1 where the beginning and end of the QRS complex (J point) can be seen (└┘).The only condition associated with a QRS complex that is ≥ 0.24 ...

producing sine wave pattern is rare to observe in routine clinical practice. Sine wave pattern in hyperkalemia is attributed to widening of QRS with ST elevation and tented T wave merging together with loss of P wave and prolongation of PR interval (Ettinger et al., 1974). ECG is a simple tool to

The initial ECG obtained upon arrival shows what is commonly referred to as a sine wave pattern. This patient does have a biventricular pacemaker which would ordinarily create a wide QRS complex mimicking an intraventricular conduction delay. However, the QRS complex here is exceptionally wide, in excess of 400 milliseconds (normal: less than 120 milliseconds).

Tall hyperacute T wave, flattened P wave, and prolonged PR and QRS intervals, which in extreme cases assume a sine wave pattern, have been commonly reported . We present a case of severe hyperkalemia with uncommon ECG findings.

Potassium is 1 of 3 critical electrolytes involved in the function of the action potential of cardiac muscle cells (the others are calcium and sodium). The most significant role for potassium occurs in phase 3 of the action potential, when potassium moves out of the cell to return the resting membrane potential (RMP) to a negative state (repolarization). Serum potassium (measured in mEq/L) is ...

Sine-wave pattern on the electrocardiogram and hyperkalaemia J Cardiovasc Med (Hagerstown). 2007 Sep;8(9):729-31. doi: 10.2459/01.JCM.0000285314.23530.87. Authors Virginia Scarabeo 1 , Maria Stella Baccillieri, Attilio Di Marco, Fabio de Conti, Francesco Contessotto, Piergiuseppe Piovesana. Affiliation 1 Department of Cardiology, Camposampiero ...

WHAT THE ECG SHOWS The ECG rhythm strip (Figure 1) shows a wide, regular QRS-complex rhythm with a sine-wave configuration and the absence of discern-ible P waves. The 12-lead ECG (Figure 2) shows similar findings: markedly widened QRS complexes with a sine-wave morphology and undiscernible P waves. The findings on both the rhythm strip and the 12-lead ECG are consistent with the ...