Double counting of heart rate by interpretation software: a new electrocardiographic sign of severe hyperkalemia (original) (raw)
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ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients
BMC Emergency Medicine
Background: In periarrest situations and during resuscitation it is essential to rule out reversible causes. Hyperkalemia is one of the most common, reversible causes of periarrest situations. Typical electrocardiogram (ECG) alterations may indicate hyperkalemia. The aim of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients. Methods: 170 patients with normal potassium (K +) levels and 135 patients with moderate (serum K + = 6.0-7.0 mmol/l) or severe (K + > 7.0 mmol/l) hyperkalemia, admitted to the Department of Emergency Medicine at the Somogy County Kaposi Mór General Hospital, were selected for this retrospective, cross-sectional study. ECG obtained upon admission were analyzed by two emergency physicians, independently, blinded to the objectives of the study. Statistical analysis was performed using SPSS22 software. χ 2 test and Fischer exact tests were applied. Results: 24% of normokalemic patients and 46% of patients with elevated potassium levels had some kind of ECG alteration suggestive of hyperkalemia. Wide QRS (31.6%), peaked T-waves (18.4%), Ist degree AV-block (18.4%) and bradycardia (18.4%) were the most common and significantly more frequent ECG alterations suggestive of hyperkalemia in severely hyperkalemic patients compared with normokalemic patients (8.2, 4.7, 7.1 and 6.5%, respectively). There was no significant difference between the frequency of ECG alterations suggestive of hyperkalemia in normokalemic and moderately hyperkalemic patients. Upon examining ECG alterations not typically associated with hyperkalemia, we found that prolonged QTc was the only ECG alteration which was significantly more prevalent in both patients with moderate (17.5%) and severe hyperkalemia (21.1%) compared to patients with normokalemia (5.3%). Conclusions: A minority of patients with normal potassium levels may also exhibit ECG alterations considered to be suggestive of hyperkalemia, while more than half of the patients with hyperkalemia do not have ECG alterations suggesting hyperkalemia. These results imply that treatment of hyperkalemia in the prehospital setting should be initiated with caution. Multiple ECG alterations, however, should draw attention to potentially life threatening conditions.
Marked Symptomatic Bradycardia Associated with Profound Hyperkalemia
Emergency Medicine: Open Access, 2012
Background and objectives: Hyperkalemia is a common disorder presents to Emergency Department (ED) with different type of presentations, one of them is cardiac dysrythmia which can be lethal if potassium level is not normalized quickly and cardiac cells stabilized by calcium in appropriate manner. We hypothesize that administration of calcium and potassium lowering drugs will prevent the need for aggressive intervention for patient with sever hyperkalemia and very slow heart rate with decrease level of consciousness. Design and setting: Prospective, patient presented to academic emergency department. Patient and method: On arrival to the emergency department, patient was confused with a lethargic mental status and pulse rate of 41 beat per minute. Blood samples were sent for immediate determination of venous blood gas (VBG) concentrations, which showed potassium concentration of 7.85 mmol/L. The patient was immediately started on hyperkalemia treatment including 2 g calcium chloride was administered intravenously (IV) over 5 minutes. The patient started to regain consciousness and recognize her family with 10 minutes of these treatments. Results: A repeat ECG showed atrial fibrillation, which is similar to the patient's baseline ECG before this admission. Repeat VBG results 90 minutes later showed pH 7.22, Pco 2 39.8 mm Hg, Po 2 26.5 mm Hg, HC0 3 15.9 mmol/L, and potassium 6.00 mmol/L. These interventions led to an almost immediate resolution of the sever bradycardia without the need for temporary cardiac pacing. Conclusion: Life-threatening hyperkalemia should be suspected in any patient with acute onset bradycardia who presents to the emergency department. Blood potassium concentration should be determined immediately by rapid point-of-care tests for an early diagnosis and appropriate medical treatment. Sufficient agreement is found in potassium levels obtained from a chemistry laboratory analyzer and a VBG analyzer.
International Journal of Medical Science and Public Health, 2017
Insulin, catecholamines, and acid-base balance affect to move potassium into the cells. 90% of the potassium is excreted from the kidney. Therefore, renal function is important in ensuring the potassium balance. [1-4] Hyperkalemia is defined as a serum potassium concentration above 5.0 mmol/l. [4] Potassium ≥10 mEq/L is often fatal. [5] Clinical findings of hyperkalemia depend on electrophysiological distortion. In hyperkalemic state, cardiac effects of potassium occur due to the cell membrane depolarization. Hyperkalemia slows the ventricular neurotransmission. [1,2,6] Background: Hyperkalemia is the life-threatening problem. Early diagnosis and treatment of patients with the possibility of hyperkalemia should be performed in emergency department. Comorbid diseases used medications and electrocardiography (ECG) findings can be important clues for the possibility of hyperkalemic states. Objectives: In our study, we aimed to identify causes of hyperkalemia in patients who admitted to emergency department and to evaluate the importance of the relationship between hyperkalemia and ECG. Materials and Methods: Our study desing was prospective. The patients who admitted to emergency department which has annual turnover of 70,000 patients between June 01, 2012, and June 01, 2014, were investigated. Total 100 patients aged 18 years and above who had hyperkalemia were included in the study. Patients were divided into three groups according to the level of potassium (1-mild: 5-5.9 mEq/L, 2-moderate: 6-7 mEq/L, 3-severe: >7 meq/L) and ECG finding of these hyperkalemic patients were evaluated. Patients were categorized according to etiology of hyperkalemia in four groups. They are chronic renal failure (CRF), acute renal failure (ARF), (angiotensinconverting-enzyme inhibitor /angiotensin-receptor blocker (ACEI/ARB) use and spironolactone use. Results: In our study, we included 100 patients with hyperkalemia. Potassium value of patients was maximum 8.1 mEq/L and mean value was 6.12 +/− 0.66 mEq/L. There was no significant correlation between the ECG and potassium level (P = 0.107). In our study, we found that the most contributing cause was CRF, the second was ARF and the third was ACEI/ARB +/− spironolactone. Conclusions: According to our study, it should be kept in mind that even if the ECG findings are normal, hyperkalemia may occur in patients with ARF, CRF, spironolactone, and ACEI/ARB drug users.
Severe hyperkalemia with minimal electrocardiographic manifestations
Journal of Electrocardiology, 1999
Severe hyperkalemia with minimal or nonspecific electrocardiographic (ECG) changes is unusual. We report data on seven patients with renal failure, metabolic acidosis, and severe hyperkalemia (K + -> 8 mmol/L) without typical ECG changes. Initial ECGs revealed sinus rhythm and PR and QT intervals in the normal range. QRS intervals were slightly prolonged in two patients (110 ms), and incomplete right bundle branch block was evident in one. Thus, the absence of typical ECG changes does not preclude severe hyperkalemia.
Atrioventricular and intraventricular conduction in hyperkalemia
The American Journal of Cardiology, 1975
Electrophysioiogic studies using His bundle recording and atriai pacing in one patient revealed intraatrial conduction delay and marked prolongation of conduction time in the His-Purkinje system. it is concluded that conduction defects in the specialized intraventricuiar conduction system are common in hyperkaiemia and result in electrocardiographic patterns of fascicular block.