Question 18.3

The following ECG (labelled ECG 3.) is that of an 83-year-old female found by her neighbour collapsed on the bathroom floor.

  • List the abnormalities shown on the ECG.
  • What do these abnormalities indicate?

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College Answer


Profound bradycardia

J (Osborn) waves

Atrial fibrillation

Shivering artefact





The ECG I used above comes from LITFL and was not part of the CCIM paper.

I was luckty to find it; and it contains everything in the college answer, including LVH by voltage criteria and even shivering artifact.


Montague, Brian T., Jason R. Ouellette, and Gregory K. Buller. "Retrospective review of the frequency of ECG changes in hyperkalemia." Clinical Journal of the American Society of Nephrology 3.2 (2008): 324-330.

Weisberg, Lawrence S. "Management of severe hyperkalemia." Critical care medicine 36.12 (2008): 3246-3251.