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Figure 1. A 42-year-old woman with end-stage renal disease from recurrent nephrolithiasis was admitted to the hospital for placement of an arteriovenous fistula for permanent hemodialysis access. While she was undergoing dissection of the brachial artery with local anesthesia, her heart rhythm converted from normal sinus rhythm to complete heart block with a ventricular escape (approximately 25 beats per minute) (Panel A). Two ampules of calcium gluconate (9.2 mEq) were administered intravenously. An electrocardiogram revealed sinus tachycardia with profound prolongation of the QRS interval (left-bundle-branch morphology), first-degree atrioventricular block, and "peaked" T waves (Panel B). The serum potassium concentration . . . [Full Text of this Article] |
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