sine wave pattern

A patient with ischemic heart failure presents with muscle weakness and fatigue. What this ECG shows is typical features of hyperkalemia. It is associated with a variety of changes on the ECG.

• Tall peaked T waves with a shortened QT interval are usually the first findings.
• As the level of K increases, there is progressive lengthening of the PR interval and QRS duration,
• the P wave may disappear,
• and ultimately the QRS widens further to a sine wave pattern.

It can end up with complete absence of electrical activity. ECG manifestations can evolve rapidly and unpredictably. Hyperkalemia should be treated as soon as possible. If left untreated, asystole followed by hemodynamic collapse and death may occur.