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9.EKGs OF ELECTROLYTES AND ENVIRONMENTAL DISTURBANCES

 

Electrolyte Disturbances

1. Magnesium

Both hypo or hypermagnesemia may lead to QT-prolongation and R on T phenomena. Both may precipitate the development of ventricular tachycardia.

2. Potassium

›› Hypokalemia
- Reduced T-wave voltage
- QRS-prolongation (K + <1.5 ) **********************
- Increased U-wave voltage, to the extent that the U-wave is longer than the T-wave in a few leads
- Pseudo-QT prolongation (actually QU-prolongation)
- ST-segment depression, which may appear ischemic
- An arrhythmia of any sort which are usually resistant to the conventional anti-arrhythmics until the hypokalemia is corrected

›› Hyperkalemia
The relation between serum potassium and EKG changes are outlined below:

 

Serum K+ ECG findings
5.5-7.8 Tall symmetrical T-waves (> 10mm) in the precordial leads
7.8-8.0 7.8-8.0 1st degree heart block, followed by P-wave widening, and atrial arrest
>8.0 Gradual QRS widening *( uniform slurring) compared to the initial slurring in WPW and the terminal slurring in BBB
Here the Rand T-waves are of the same height with the development of SINE wave

Due to the association of hyperkalemia with cardiac arrest, an EKG is always recommended to evaluate the patients with suspected hyperkalemia

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3. Calcium:

›› Hypocalcemia may cause:
- QT-prolongation mainly in the ST segment with normal T-wave duration
- T-wave inversion may occur in 30% of cases
- One may seen R on T phenomena which may result in ventricular tachycardia
›› Hypercalcemia may cause:
- shortening of the QT-interval
- the tendency to digitalis toxicity to be enhanced

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Hypothermic EKG changes

The relationship of the temperature to the EKG changes

Although hypothermia is commonly seen as an accidental event, it also can be seen in controlled conditions such as cardiovascular surgeries

 

Temperature °C EKG changes
35 sinus bradycardia, T-wave flatten
30-35 30-35 PR interval, QRS and ST-segment with QT prolongation (J-wave or Osborne wave appears late in the QR).
27-30 27-30 Ventricular arrhythmias may occur
26 or less Various degrees of heart block
10 or less Cardiac arrest

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