Hyperkalemia electrocardiogram
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]
Overview
Hyperkalemia (AE) or Hyperkalaemia (BE) is an elevated blood level (above 5.0 mmol/L) of the electrolyte potassium. The prefix hyper- means high (contrast with hypo-, meaning low). The middle kal refers to kalium, which is Latin for potassium. The end portion of the word, -emia, means "in the blood". Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias.
Electrocardiogram
Electrocardiography (ECG) is generally done early to identify any influences on the heart, as hyperkalemia may cause fatal arrhythmias. With moderate hyperkalemia, there is reduction of the size of the P wave and development of tent-shaped T waves. Further hyperkalemia will lead to widening of the QRS complex, that ultimately may become sinusoidal in shape. There appears to be a direct effect of elevated potassium on some of the potassium channels that increases their activity and speeds membrane repolarization. Also, (as noted above), hyperkalemia causes an overall membrane depolarization that inactivates many sodium channels. The faster repolarization of the cardiac action potential causes the tenting of the T waves, and the inactivation of sodium channels causes a sluggish conduction of the electrical wave around the heart, which leads to smaller P waves and widening of the QRS complex.
Spcific findings include the following:
Tall, narrow, and peaked T waves
- Earliest sign of hyperkalemia
- Occurs with K > 5.5 meq/li
- Differential diagnosis of this EKG change includes the T wave changes of bradycardia or stroke. Prominent U waves and QTc prolongation are more consistent with stroke than hyperkalemia.
Intraventricular conduction defect
Decrease of the amplitude of the P wave or an absent P wave
- Decreased P wave amplitude occurs when the K is > 7.0 meq/li
- P waves may be absent when the K is > 8.8 meq/li
- The impulses are still being generated in the SA node and are conducted to the ventricles through specialized atrial fibers without depolarizing the atrial muscle
- Moderate or sever hyperkalemia can cause sinus arrest [1]
ST segment changes simulating current of injury
- Have been labeled the dialyzable current of injury
Cardiac arrhythmias: bradyarrhythmias, tachyarrhythmias, atrioventricular conduction defects
- Occurs with severe hyperkalemia, not mild to moderate hyperkalemia
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Tall, symmetric, narrow based T waves in a hyperkalemic patient.
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A patient's EKG with hyperkalemia.
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Same patient's EKG during treatment.
References
- ↑ Bonvini RF, Hendiri T, Anwar A (2006). "Sinus arrest and moderate hyperkalemia". Annales De Cardiologie Et D'angéiologie. 55 (3): 161–3. PMID 16792034. Unknown parameter
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