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TO OUR knowledge, His bundle electrograms have never been obtained from a patient with hyperkalemia. We describe serial His bundle electrograms obtained from a patient with hyperkalemia caused by exogenous administration of potassium. Report of a Case An 80-year-old woman was admitted to Fordham Hospital because of shortness of breath. She was in excellent health until six months before admission when occasional bouts of dyspnea on exertion appeared. These episodes became more severe in the week preceding the hospitalization. On examination, her blood pressure was 160/80 mm Hg, her pulse rate was 90 beats per minute, with occasional premature beats, and her temperature was 38.2 C (100.8 F). Neck veins were prominent and rales were heard at both lung bases. The point of maximal cardiac impulse was in the sixth intercostal space beyond the midclavicular line. There were no murmurs or gallops. The liver was two fingerbreadths below the right

In order to avoid confusion in discussion of the group of cases that I am reporting, it is necessary to bear in mind a precise definition of the signs of heart failure of the congestive type. Whatever may be the complete pathologic physiology in congestive heart failure, the physical signs by which we can recognize it clinically are few and definite. They depend on actual venous congestion from a failure of the heart to pump away the blood as fast as it receives it, and are, in differing proportions in individual cases: (1) from congestion in the pulmonary veins; diminshed vital capacity; orthopnea; râles, particularly in the dependent portions of the lungs; cough, perhaps productive, perhaps hemoptysis; (2) from congestion of the systemic veins; liver enlargement, with possibly tenderness and pain. There may be an accompanying demonstrable congestion of the neck veins. Demonstrable general edema often comes late in the