Junctional Rhythm with Hyperkalemia

Vignette: 40 yo with h/o HTN, HLD and CKD c/o chest pain. 

Image 1

This is a regular, wide QRS rhythm with a ventricular rate of about 37 per minute with no discernible P waves and tented T waves in the precordial leads. This is junctional rhythm, intraventricular conduction delay with hyperkalemia (K7.2) as manifested in the 12L ecg with T wave tenting. 

#689