This strip offers several good teaching opportunities. If it were a 12-lead ECG, no doubt it would be a bonanza! First, there is sinus tachycardia at a rate of about 138 per minute. The P waves are all alike and regular. The T waves are tall and narrow, with a sharp peak. This is often a transient sign of hyperkalemia, and should be investigated with serum electrolyte tests and with a 12-lead ECG. In addition, the baseline shows a wandering type of artifact. This is due to the patient's deep breathing, and the fact that the arm electrodes were placed on the chest. This patient was a diabetic in ketoacidosis with hyperkalemia.
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