Electrolyte Disorders: Difference between revisions

From ECGpedia
Jump to navigation Jump to search
 
(33 intermediate revisions by 9 users not shown)
Line 1: Line 1:
{{ActiveDiscuss}}
{{authors|
|mainauthor= [[user:Drj|J.S.S.G. de Jong]]
|moderator= [[T.T. Keller]]
|supervisor=
}}
==Hyperkalemia==
ECG characteristics of hyperkalemia, high blood potassium:
*P-waves are widened and of low amplitude due to slowing of conduction
*QRS complex:
**QRS widening
**fusion of QRS-T
**loss of the ST segment
*Tall tented T waves


===Hypercalciëmie===
The initial part of the QRS complex is often spared as purkinje fibers are less sensitive to hyperkalemia.
These changes can also occur in acidosis (via the same mechanism) and during Class IC anti-arrhythmic intoxication.


Hypercalciëmie bevordert een snelle repolarisatie. Dit leidt tot:
At concentrations > 7.5 mmol/L atrial and [[Ventricular Fibrillation|ventricular fibrillation]] can occur.
 
<gallery consecutive ECGs of a patient with severe hypokalemia>
*milde hypercaliëmie: hoge spitse tentvormige T-toppen met een smalle basis
Image:KJcasu18-3.jpg|Consecutive ECGs of a patient with hyperkalemia. ECG1
*ernstige hypercaliëmie: extreem verbreed QRS, lage R, afwezige P-top en hoge spitse T-top
Image:KJcasu18-2.jpg|Consecutive ECGs of a patient with hyperkalemia. ECG2
*symptomen: irritatie, slaperigheid, spiezwakte, perifere neuropathies, anorexie, constipatie
Image:KJcasu18-1.jpg|Consecutive ECGs of a patient with hyperkalemia. After correction of potassium levels. ECG3
 
File:DVA0578.jpg|Another patient, potassium of 9.4 mmol/L
cave: hypercalciëmie induceert digitalis toxiciteit
File:E000561.jpg|Potassium 7.5 mmol/L. [[Answer_-_Case_of_the_month_(Oct_2011)|More ECGs]]
 
</gallery>
===Hypocalciëmie===
 
In tegenstelling tot ''hyper''-calciëmie leidt ''hypo''-calciëmie tot:
 
*lichte afname van de QRS-duur
*PR-duur kan afgenomen zijn
*verlaging en omkering T-top
*verlenging QT-interval
*uitgesproken U-golf
*verlengd ST-segment en ST-depressie
 
Symptomen: spierkrampen, convulsies, gevoelloosheid en tintelingen. Symptomen van [[w:Chvostek's_sign|Chvostek]] en [[w:Trousseau_sign|Trousseau]] kunnen opgewekt worden.
 
cave: afname calcium leidt tot toename natrium entry in de cellen met als gevolg herhaaldelijk vuren van de zenuwen; Dit kan leiden tot cardiale aritmieën.
 
===Hyperkaliëmie===
[[Image:ecg_hyperkaliemie.jpg|thumb| Een ECG bj extreme hyperkaliemie. Geen p-toppen, verbreed QRS, hoge T toppen.]]
[[Image:ecg_hyperkaliemie2.jpg|thumb| Zelfde patient, het kaliumgehalte is inmidels iets gecorrigeerd. Nog steeds geen p-toppen, verbreed QRS, hoge T toppen.]]
*Een verhoogd kalium gehalte leidt tot een spitsere en hogere T-top.  
*Daarnaast wordt de P-top vlakker en is zelf bij extreme hyperkaliëmie niet meer zichtbaar.  
*Ten slotte leidt een verhoogd serumkaliumgehalte tot een langere depolarisatie van de kamers m.a.g. een bredere QRS-complex.
(bij concenraties >7.5mmol/l kan er aamleiding zijn tot zowel boezem- en kamerstilstand als kamerfibrilleren.
{{clr}}
{{clr}}


===Hypokalemia===
==Hypokalemia==
[[Image:KJcasu18-3.jpg|thumb| Consecutive ECGs of a patient with hypokalemia. ECG1]]
Hypokalemia, low blood potassium, results in:
[[Image:KJcasu18-2.jpg|thumb| Consecutive ECGs of a patient with hypokalemia. ECG2]]
[[Image:KJcasu18-1.jpg|thumb| Consecutive ECGs of a patient with hypokalemia. After correction of potassium levels.]]
Hypokalemia is a low blood potassium level. This results in:
*ST depression and flattening of the T wave
*ST depression and flattening of the T wave
*Negative T waves
*Negative T waves
*A U-wave may be visible
*A U-wave may be visible
<gallery>
Image:Hypokalemia.jpg| A patient with hypokalemia, prominent QT prolongation. Not the extrasystoles originating from the prolonged T/U wave. This patient definitely needs rhythm monitoring
Image:KJcasu17-1.jpg| patient A
Image:KJcasu17-2.jpg| patient A
Image:KJcasu17-3.jpg| patient B
Image:JJ0003.jpg| Patient C, Potassiumlevel of 1.5
</gallery>
{{clr}}
{{clr}}
==Hypercalcemia==
Hypercalcemia, high blood calcium, speeds repolarization. Characteristics of hypercalcemia:
*Mild: broad based tall peaking T waves
*Severe: extremely wide QRS, low R wave, disappearance of p waves, tall peaking T waves.
<gallery>
File:E000546.jpg|A patient with severe hypercalcemia: Calcium 4.6 mmol/L, albumin 37 g/L
</gallery>
==Hypocalcemia==
ECG-characteristics of hypocalcemia, low blood calcium:
*Narrowing of the QRS complex
*Reduced PR interval
*T wave flattening and inversion
*Prolongation of the QT-interval
*Prominent U-wave
*Prolonged ST and ST-depression
<gallery>
File:E000800.jpg|An ECG of a patient with hypocalcemia
</gallery>

Latest revision as of 12:23, 3 September 2014

Author(s) J.S.S.G. de Jong
Moderator T.T. Keller
Supervisor
some notes about authorship

Hyperkalemia

ECG characteristics of hyperkalemia, high blood potassium:

  • P-waves are widened and of low amplitude due to slowing of conduction
  • QRS complex:
    • QRS widening
    • fusion of QRS-T
    • loss of the ST segment
  • Tall tented T waves

The initial part of the QRS complex is often spared as purkinje fibers are less sensitive to hyperkalemia. These changes can also occur in acidosis (via the same mechanism) and during Class IC anti-arrhythmic intoxication.

At concentrations > 7.5 mmol/L atrial and ventricular fibrillation can occur.

  • Consecutive ECGs of a patient with hyperkalemia. ECG1

    Consecutive ECGs of a patient with hyperkalemia. ECG1

  • Consecutive ECGs of a patient with hyperkalemia. ECG2

    Consecutive ECGs of a patient with hyperkalemia. ECG2

  • Consecutive ECGs of a patient with hyperkalemia. After correction of potassium levels. ECG3

    Consecutive ECGs of a patient with hyperkalemia. After correction of potassium levels. ECG3

  • Another patient, potassium of 9.4 mmol/L

    Another patient, potassium of 9.4 mmol/L

  • Potassium 7.5 mmol/L. More ECGs

    Potassium 7.5 mmol/L. More ECGs


Hypokalemia

Hypokalemia, low blood potassium, results in:

  • ST depression and flattening of the T wave
  • Negative T waves
  • A U-wave may be visible
  • A patient with hypokalemia, prominent QT prolongation. Not the extrasystoles originating from the prolonged T/U wave. This patient definitely needs rhythm monitoring

    A patient with hypokalemia, prominent QT prolongation. Not the extrasystoles originating from the prolonged T/U wave. This patient definitely needs rhythm monitoring

  • patient A

    patient A

  • patient A

    patient A

  • patient B

    patient B

  • Patient C, Potassiumlevel of 1.5

    Patient C, Potassiumlevel of 1.5


Hypercalcemia

Hypercalcemia, high blood calcium, speeds repolarization. Characteristics of hypercalcemia:

  • Mild: broad based tall peaking T waves
  • Severe: extremely wide QRS, low R wave, disappearance of p waves, tall peaking T waves.
  • A patient with severe hypercalcemia: Calcium 4.6 mmol/L, albumin 37 g/L

    A patient with severe hypercalcemia: Calcium 4.6 mmol/L, albumin 37 g/L

Hypocalcemia

ECG-characteristics of hypocalcemia, low blood calcium:

  • Narrowing of the QRS complex
  • Reduced PR interval
  • T wave flattening and inversion
  • Prolongation of the QT-interval
  • Prominent U-wave
  • Prolonged ST and ST-depression
  • An ECG of a patient with hypocalcemia

    An ECG of a patient with hypocalcemia

Retrieved from "https://en.ecgpedia.org/index.php?title=Electrolyte_Disorders&oldid=16879"