Hypokalemia electrocardiogram: Difference between revisions

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__NOTOC__
{{Hypokalemia}}
{{Hypokalemia}}
{{CMG}}'''; Associate Editor-In-Chief:''' {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[User:Jack Khouri|Jack Khouri]]
{{CMG}}'''; Associate Editor-In-Chief:''' {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[User:Jack Khouri|Jack Khouri]]
==Overview==
==Overview==
The most notable EKG findings in [[hypokalemia]] are due to the delayed ventricular repolarization manifesting as (QT-U) with prominent U waves. It is commonly seen at potassium levels <3 meq/L (90% of patients with potassium levels <2.7 meq/L have abnormal ECG findings). However, these changes are rapidly reversible with potassium repletion
The most notable EKG findings in [[hypokalemia]] are due to the delayed ventricular repolarization, manifesting as (QT-U) with prominent [[U waves]]. The EKG changes of hypokalemia are commonly seen at potassium levels < 3 meq/Li. 90% of the patients with potassium levels <2.7 meq/L have abnormal ECG findings.


==ECG changes==
==Electrocardiogram==
# ST segment depression, decreased T wave amplitude, prominent U waves
===ECG Changes===
#* seen in 78% of patients with a K < 2.7 meq
# [[ST segment depression]], decreased [[T wave]] amplitude, and prominent [[U waves]]:
#* seen in 35% of patients with a K > 2.7 and < 3.0
#* Seen in 78% of patients with a K < 2.7 meq
#* seen in 10% of patients with a K > 3.0 and < 3.5
#* Seen in 35% of patients with a K > 2.7 and < 3.0
#* U waves are also prominent in bradycardia and LVH
#* Seen in 10% of patients with a K > 3.0 and < 3.5
# Prolongation of the QRS duration
#* [[U waves]] are also prominent in [[bradycardia]] and [[LVH]]
#* uncommon except in severe hyperkalemia
# [[Prolongation of the QRS]] duration
# Increase in the amplitude and duration of the P-wave
#* Uncommon except in severe hyperkalemia
# Cardiac arrhythmias and AV block
# Increase in the amplitude and duration of the [[P-wave]]
# '''Contrary to popular belief there is not prolongation of the QTc''', this is artifactually prolonged due to the U wave. In some cases there is fusion of the T and the U wave making interpretation impossible.
# [[Cardiac arrhythmias]] and [[AV block]]
# Contrary to popular belief there is not prolongation of the QTc, this is artifactually prolonged due to the U wave. In some cases there is fusion of the T and U waves making interpretation impossible.
# Ventricular ectopy
#* [[Premature ventricular complex]]
#* [[Ventricular tachycardia]]
#* [[Ventricular fibrillation]]


==ECG Imaging==
===ECG Examples===
<div align="left">
<gallery heights="175" widths="175">
Image:Hypokalemia.jpg|Long QT interval, ST segment depression, low T waves amplitude and TU wave fusion in a hypokalemic patient.
Image:KJcasu18-3.jpg|Consecutive ECGs of a patient with hypokalemia. ECG1
</gallery>
</div>


Shown below is an example of [[hypokalemia]] with [[long QT interval]], [[ST segment depression]], low T waves amplitude and TU wave fusion.
[[Image:Hypokalemia.jpg|center|500px]]
----
Shown below is an example of hypokalemia with [[Left Ventricular Hypertrophy]].
[[Image:V10.ht14.jpg|center|500px]]
----
The EKG below demonstrates characteristics of [[hypokalemia]] including: [[T wave inversion]]s and U waves circled in red; flattening of [[ST segment]] and prolonged Q- U interval as circled in green.
[[Image:Untitled.png|center|500px]]
----


<div align="left">
The EKG changes of hypokalemia are rapidly reversible with potassium repletion.
<gallery heights="117" widths="117">
Image:KJcasu18-2.jpg|Consecutive ECGs of a patient with hypokalemia. ECG2
Image:KJcasu18-1.jpg|Consecutive ECGs of a patient with hypokalemia. After correction of potassium levels.
Image:V10.ht14.jpg|Hypokalemia with LVH. Image courtesy of Dr Jose Ganseman
</gallery>
</div>


==References==
==References==

Latest revision as of 20:36, 21 October 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Assistant Editor(s)-In-Chief: Jack Khouri

Overview

The most notable EKG findings in hypokalemia are due to the delayed ventricular repolarization, manifesting as (QT-U) with prominent U waves. The EKG changes of hypokalemia are commonly seen at potassium levels < 3 meq/Li. 90% of the patients with potassium levels <2.7 meq/L have abnormal ECG findings.

Electrocardiogram

ECG Changes

  1. ST segment depression, decreased T wave amplitude, and prominent U waves:
    • Seen in 78% of patients with a K < 2.7 meq
    • Seen in 35% of patients with a K > 2.7 and < 3.0
    • Seen in 10% of patients with a K > 3.0 and < 3.5
    • U waves are also prominent in bradycardia and LVH
  2. Prolongation of the QRS duration
    • Uncommon except in severe hyperkalemia
  3. Increase in the amplitude and duration of the P-wave
  4. Cardiac arrhythmias and AV block
  5. Contrary to popular belief there is not prolongation of the QTc, this is artifactually prolonged due to the U wave. In some cases there is fusion of the T and U waves making interpretation impossible.
  6. Ventricular ectopy

ECG Examples

Shown below is an example of hypokalemia with long QT interval, ST segment depression, low T waves amplitude and TU wave fusion.


Shown below is an example of hypokalemia with Left Ventricular Hypertrophy.


The EKG below demonstrates characteristics of hypokalemia including: T wave inversions and U waves circled in red; flattening of ST segment and prolonged Q- U interval as circled in green.


The EKG changes of hypokalemia are rapidly reversible with potassium repletion.

References


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