Sine wave pattern: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
* | * [[Hyperkalemia]] induces electrophysiologic changes in the [[myocardium]] leading to a series of findings on [[EKG]]. Sine wave pattern is a manifestation of severe [[hyperkalemia]]. | ||
* Different level of [[hyperkalemia]] causes different electrophysiologic changes, the first sign of which is inverted [[T wave]]s that are the result of accentuation of [[repolarization]]. | * Different level of [[hyperkalemia]] causes different electrophysiologic changes, the first sign of which is inverted [[T wave]]s that are the result of accentuation of [[repolarization]]. | ||
* Further increase in the [[potassium]] level leads to a decrease of the velocity of cardiac conduction causing [[prolonged PR interval|PR interval prolongation]], [[QRS widening]], decrease in the amplitude of [[P wave]]s and eventually absence of [[P wave]]s. It is important to note that the absence of [[P wave]]s does not depict [[sinus arrest]] at this level; in fact, the [[SA node]] continues to function without causing atrial contraction but rather only ventricular contraction. This rhythm is referred to as sinoventricular rythm. | * Further increase in the [[potassium]] level leads to a decrease of the velocity of cardiac conduction causing [[prolonged PR interval|PR interval prolongation]], [[QRS widening]], decrease in the amplitude of [[P wave]]s and eventually absence of [[P wave]]s. It is important to note that the absence of [[P wave]]s does not depict [[sinus arrest]] at this level; in fact, the [[SA node]] continues to function without causing atrial contraction but rather causing only ventricular contraction. This rhythm is referred to as sinoventricular rythm. | ||
* As the [[potassium]] level further increases, the delay in cardiac conduction increases leading to further widening of the [[QRS segment]] which ends up in the fusion of the [[QRS wave]] with the [[T wave]]. The fusion of the [[QRS complex]] with the [[T wave]] in the absence of [[P wave]] is referred to as the sine wave pattern. | * As the [[potassium]] level further increases, the delay in cardiac conduction increases leading to further widening of the [[QRS segment]] which ends up in the fusion of the [[QRS wave]] with the [[T wave]]. The fusion of the [[QRS complex]] with the [[T wave]] in the absence of [[P wave]] is referred to as the sine wave pattern. | ||
==Differential Diagnosis== | |||
* [[Ventricular tachycardia]] | |||
* [[SVT]] with [[bundle branch block]] | |||
==References== | ==References== | ||
Revision as of 21:06, 29 July 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Rim Halaby
Overview
Pathophysiology
- Hyperkalemia induces electrophysiologic changes in the myocardium leading to a series of findings on EKG. Sine wave pattern is a manifestation of severe hyperkalemia.
- Different level of hyperkalemia causes different electrophysiologic changes, the first sign of which is inverted T waves that are the result of accentuation of repolarization.
- Further increase in the potassium level leads to a decrease of the velocity of cardiac conduction causing PR interval prolongation, QRS widening, decrease in the amplitude of P waves and eventually absence of P waves. It is important to note that the absence of P waves does not depict sinus arrest at this level; in fact, the SA node continues to function without causing atrial contraction but rather causing only ventricular contraction. This rhythm is referred to as sinoventricular rythm.
- As the potassium level further increases, the delay in cardiac conduction increases leading to further widening of the QRS segment which ends up in the fusion of the QRS wave with the T wave. The fusion of the QRS complex with the T wave in the absence of P wave is referred to as the sine wave pattern.