{"id":22035,"date":"2017-02-04T21:16:24","date_gmt":"2017-02-04T15:46:24","guid":{"rendered":"https:\/\/cardiophile.org\/?p=22035"},"modified":"2017-02-04T21:16:24","modified_gmt":"2017-02-04T15:46:24","slug":"ecg-in-hyperkalemia","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/ecg-in-hyperkalemia\/","title":{"rendered":"ECG in hyperkalemia"},"content":{"rendered":"<h2><span style=\"color: #008000;\">ECG in hyperkalemia<\/span><\/h2>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/9BeJPJpYNT0\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/p>\n<p><span style=\"line-height: 1.5;\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-32329 size-full\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2017\/02\/hyperkalemia-2.jpg\" alt=\"ECG in hyperkalemia\" width=\"1780\" height=\"679\">In this <a href=\"https:\/\/johnsonfrancis.org\/professional\/ecg-changes-in-hyperkalemia-mechanism\/\">ECG some features due to hyperkalemia<\/a> are visible:<\/span><\/p>\n<ol>\n<li style=\"text-align: left;\">Tall T waves &#8211; T waves in anterior leads are as tall as or taller than the QRS complexes, though the absolute amplitudes are not very high. Typical description in hyperkalemia is tall tented T waves.<\/li>\n<li style=\"text-align: left;\">QRS widening, with right bundle branch block like pattern<\/li>\n<li style=\"text-align: left;\">Lack of atrial electrical activity&nbsp;&#8211; no P waves are visible and there is bradycardia. It could very well be a slow junctional rhythm. Ideally if there was sinus arrhythmia visible in the QRS complex intervals, one could have presumed that there is sinus node activity with <em>atrial paralysis<\/em> and <em>sinoventricular conduction<\/em> [1].<\/li>\n<\/ol>\n<p>In severe hyperkalemia, QRS becomes very wide and merges with T wave to produce a&nbsp;<em>sine wave pattern<\/em> (not seen in the ECG illustrated above) in which there will be no visible ST segment [2]. In the case reported by Pluijmen MJ et al [2], the patient was hemodynamically stable, but presented with quadriplegia, had heart rate 45\/min and had end stage renal disease. Serum potassium was 9.9 mmol\/L. Intravenous calcium gluconate was given and emergency dialysis performed. Sinus rhythm was maintained once normokalemia was achieved.<\/p>\n<p><span style=\"color: #0000ff;\"><strong>References<\/strong><\/span><\/p>\n<ol>\n<li>Maradey J, Bhave P. <a href=\"http:\/\/electrophysiology.onlinejacc.org\/content\/4\/5\/701\">Sinoventricular Conduction in the Setting of Severe Hyperkalemia<\/a>. JACC Clin Electrophysiol. 2018 May;4(5):701-703.<\/li>\n<li>Pluijmen MJ, Hersbach FM. <a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.106.687202\">Images in cardiovascular medicine. Sine-wave pattern arrhythmia and sudden paralysis that result from severe hyperkalemia<\/a>. Circulation. 2007 Jul 3;116(1):e2-4.<\/li>\n<\/ol>\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>ECG in hyperkalemia In this ECG some features due to hyperkalemia are visible: Tall T waves &#8211; T waves in anterior leads are as tall as or taller than the QRS complexes, though the absolute amplitudes are not very high. Typical description in hyperkalemia is tall tented T waves. QRS widening, with right bundle branch [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":32329,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6],"tags":[90,389,1277,1744,3182,3237,3586,3598,3615,3827,3841,3842],"class_list":["post-22035","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology","tag-absence-of-p-waves","tag-atrial-paralysis","tag-ecg-in-hyperkalemia","tag-hyperkalemia","tag-qrs-widening","tag-rbbb-pattern","tag-sine-wave-pattern","tag-sinoventricular-conduction","tag-slow-junctional-rhythm","tag-t-waves-taller-than-qrs","tag-tall-t-waves","tag-tall-tented-t-waves"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ECG in hyperkalemia - tall T waves, wide QRS and absent P waves<\/title>\n<meta name=\"description\" content=\"ECG in hyperkalemia: Findings seen here are T waves taller than QRS, QRS widening and absence of P waves, which could be atrial paralysis.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/ecg-in-hyperkalemia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ECG in hyperkalemia - 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