I don't think based on this EKG alone you can be 100% sure of any of the above choices. Practically, the ischemic effects on QT interval can be unpredictable and are not enough to pin the diagnosis as there other variables that can affect it, and it may shrink or expand relative to baseline and yet still within normal limits. Same thing for the peaked T waves in hyperkalemia, as it is hard to have a very sold quantification on how tall, although in general tall T waves with narrow base are more suspicious of hyperkalemia, and a wider base (like in this case) point more towards ischemia, although I have seen exceptions. In these cases, it is so crucial to have an old EKG and correlate to a clinical setting.

In this case, the findings of Cardiac cath lab serial EKGs (with or without hyperkalemia Rx) will be the real confirmatory test.

I will share in this forum a classical DeWinter tracing that we have a few months ago at one point.

Great tracings Mohammed, you need to let us know what is the final verdict!