Permanent atrial fibrillation: Special electrocardiogram in hyperkalemia

摘要

We reported a case about the slow heart rate and regular heart rhythm that appeared after administration of digitalis, diuretics and potassium in a patient with chronic atrial fibrillation ten years. ECG characteristics demonstrated the special changes about hyperkalemia as follows: f waves disappeared; nonspecific widened QRS complex appeared; RR interval was regular; and heart rate slowed. T wave inversion reverted to be symmetrical and peaked. Laboratory investigations were noteworthy for serum potassium elevations (serum potassium was 8.50 mmol/L). In patients with chronic atrial fibrillation, digitalis administration, diuretic therapy and potassium supplementation can induce slow heart rate and regular heart rhythm. These changes may permit prompt recognition of overt digitalis toxicity-atrioventricular block. However, these have also frequently been seen in the setting of chronic renal insufficiency, resulting in hyperkalemia. The basic principles of treatment were different in these two conditions. Therefore, ECG and laboratory investigation should draw a clinician's attention. (C) 2016 Elsevier Ireland Ltd. All rights reserved.