A 60 year old female, known case of rheumatoid arthritis, come to JIPMER hospital, Pondicherry, India with chief complaints of giddiness along with dyspnoea on exertion since last two days. During examination patient pulse was 28 beats per minute, BP was 80/60 mmhg. CVS was normal, chest examination reveal bilateral crepitation till mid scapula.Patient ECG done in the emergency department is shown below. ECHO heart done in the emergency department was normal.
ECG of the patient
Description of the ECG-Heart rate around 32 beats per minute, no P wave were seen, Junctional beats present, narrow QRS morphology, QT interval 580 msec, QTc interval 420 msec, no ST-T wave changes seen.
Patient was put on urgent temporary pacemaker insertion. Blood investigation of the patient reveal severe hypokalemia with serum potassium of 2 meq/dl. Patient was started on intravenous and oral potassium supplementation but suddenly patient went into cardiac arrest and patient could be revived inspite of cardiopulmonary resuscitation.
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