ECG changes with hyperkalemia and kidney function impairment

Electrocardiogram (ECG) showing peaked T waves (most apparent in V2 to V5) that are characteristic of hyperkalemia. Note also the concomitant findings of QTc prolongation (QT = 440 msec at heart rate of 75 bpm) due to prolongation of the ST segment (eg, in V2), consistent with hypocalcemia, as well as evidence of left ventricular hypertrophy (by voltage criteria, along with left atrial abnormality). The latter finding is consistent with chronic systemic hypertension. The constellation of peaked T waves attributable to hyperkalemia, a long QT interval (ST-segment portion) due to presumed hypocalcemia, and LVH associated with hypertension has been referred to as the "renal failure triad."