Peaked Waves After Head Injury

Report:

Sinus rhythm 80/min

Borderline right axis deviation +90o

Right atrial abnormality

Tall peaked T waves ?cause

Prolonged QT interval

QTc 0.50”

Comment:

The T waves are, of course, typical of hyperkalæmia: narrow-based, tall and peaked. There was no clinical explanation for them (potassium being normal throughout) except the head injury itself. The latter probably accounts for the P-pulmonale-looking P waves as well35.

The next day (Fig 25a) she was nearing brain death, in hypothermia (note the J waves) and with a QTc of 0.52” (from both hypothermia and the original cerebral injury).

Below (Fig 25b, 25c) is another organ donor, with massive subdural hæmatoma from an MVA. She too had prominent peaked T waves with normal potassium, but the P waves remained normal, except when absent during an initial accelerated idiojunctional rhythm. They remained normal even in the impressive sinus tachycardia during a period of “storming” .

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