ECG Changes in hyperkalemia

Hyperkalemia, which is an elevated level of potassium in the blood, can lead to various changes on an electrocardiogram (ECG) due to its effects on cardiac conduction and excitability. These changes can range from subtle alterations to life-threatening arrhythmias. Here are some common ECG changes seen in hyperkalemia:

  • Peaked T waves:
  • One of the earliest ECG changes in hyperkalemia is the tall, peaked T waves. These T waves can become tall and pointed, resembling the shape of a tent or narrow spire. This is often the first sign of hyperkalemia and can occur even with mild elevations in potassium levels.

  • PR prolongation:
  • Hyperkalemia can lead to prolongation of the PR interval, which indicates delayed atrioventricular (AV) conduction. This can be observed as a widening of the PR segment on the ECG.

  • Loss of P waves:
  • As hyperkalemia progresses, there may be a loss of P waves, indicating impaired atrial depolarization. This is typically seen in severe hyperkalemia.

  • Widened QRS complex:
  • Hyperkalemia can cause widening of the QRS complex due to slowed intraventricular conduction. This is often associated with significant hyperkalemia and can predispose to ventricular arrhythmias.

  • ST segment changes:
  • In severe hyperkalemia, ST segment changes may occur, including depression or elevation. These changes are nonspecific and may be seen along with other ECG abnormalities.

  • Sine wave pattern:
  • In extreme cases of hyperkalemia, the ECG may demonstrate a sine wave pattern, where the ECG waveform resembles a sinusoidal curve. This is a life-threatening sign associated with impending cardiac arrest.

  • Ventricular arrhythmias:
  • As hyperkalemia worsens, it can lead to the development of ventricular arrhythmias such as ventricular tachycardia or ventricular fibrillation, which can result in cardiac arrest if not promptly treated.

    It’s important to note that the severity of ECG changes in hyperkalemia may not always correlate with the level of hyperkalemia. Even mild elevations in potassium levels can sometimes lead to significant ECG abnormalities, especially in individuals with underlying cardiac disease. Therefore, prompt recognition and management of hyperkalemia are essential to prevent potentially life-threatening cardiac complications.

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