This is the 12L ECG of a 70 yo patient with h/o of HTN, hyperlipidemia DM, CHF and ESRD c/o vomiting.
The 12L showed a regular wide QRS rhythm at rate of about 94 bpm, RBBB morphology and left anterior fascicular block pattern. P waves are best seen in long lead II. The QRS duration is about 200 ms which is very wide. Tall and tented T waves can be appreciated in V3. This ECG is highly suggestive of an ECG pattern of a patient with hyperkalemia.
Potassium came back at 6.5. Calcium gluconate, glucose/insulin and sodium bicarbonate were given and was dialyzed.
Interpretation: Sinus rhythm, right bundle branch block, left anterior fascicular block, hyperkalemia.