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The standout feature of this ECG is the tall 'tented' T waves in the anterior leads. This finding is associated with hyperkalaemia.

Hyperkalaemia

Plasma potassium levels are regulated by a number of factors including aldosterone, acid-base balance and insulin levels. Metabolic acidosis is associated with hyperkalaemia as hydrogen and potassium ions compete with each other for exchange with sodium ions across cell membranes and in the distal tubule. ECG changes seen in hyperkalaemia include tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole

Causes of hyperkalaemia:

    acute renal failure
    drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin**
    metabolic acidosis
    Addison's
    rhabdomyolysis
    massive blood transfusion


Foods that are high in potassium:

    salt substitutes (i.e. Contain potassium rather than sodium)
    bananas, oranges, kiwi fruit, avocado, spinach, tomatoes


*beta-blockers interfere with potassium transport into cells and can potentially cause hyperkalaemia in renal failure patients - remember beta-agonists, e.g. Salbutamol, are sometimes used as emergency treatment

**both unfractionated and low-molecular weight heparin can cause hyperkalaemia. This is thought to be caused by inhibition of aldosterone secretion