Background Tall, symmetrically peaked T waves commonly appear throughout the precordium (V1 to V6) as serum K+ rises above 5.5 mmol/L. During routine ECG analysis, we found such T waves, but they were confined to V1-3. We then ascertained these tracings belonged to a group of patients with either end-stage renal disease or who had received a renal transplant. We therefore sought to determine whether this localized T wave abnormality was a marker of hyperkalemia.
Methods Retrospective analysis of clinical and laboratory data, including serum electrolytes, blood urea nitrogen and creatinine, together with echocardiogram in 19 patients (6F; 13M), ranging in age from 30 to 67 years, whose ECG revealed this localized T wave abnormality during routine interpretation. Nine patients had end-stage renal disease and 8 had received renal and 2 renal and pancreas transplants within 11 months to 9 years.
Results Of the 19 patients with the localized T wave abnormality and renal involvement, 6 (31%) had hyperkalemia. One of these patients had end-stage renal disease and a serum K+ of 7.6 mmol/L while 5 of 10 patients with renal transplants had a serum K+ > 5.5 mmol/L and in three of these persons serum K+ was > 6.8 mmol/L. Evidence of LVH was found on ECG and/or echocardiogram in 15 of these 19 patients.
Conclusions A localized T wave abnormality, confined to V1-V3 and expressed as tall symmetrically peaked T waves, can occur in patients with end-stage renal disease or renal transplantation who have hyperkalemia. In other such persons this localized T wave abnormality may be a normal variant.