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Hypercalcemia

Hypercalcaemia, Hypercalcemia, High calcium level

Calcium (Calcium, Ca²⁺)
Causes of Hypercalcemia
ECG and Hypercalcemia
ECG Curve and Minerals

Calcium (Calcium, Ca²⁺)

Calcium is mainly responsible for repolarization of the action potential
Physiological concentration is 2.1 - 2.6 mmol/l
Hypercalcemia has 3 stages:

Mild ( 2.7 - 2.9 mmol/l ) hypercalcemia
Moderate ( 3.0 - 3.4 mmol/l ) hypercalcemia
Severe ( > 3.4 mmol/l ) hypercalcemia

Calcium is mainly found in:

Milk, cheese, and yogurt

Causes of Hypercalcemia

Most common causes of hypercalcemia

Bone metastases break down Ca²⁺ from the bone, e.g., breast carcinoma. However, metastases in prostate carcinoma support bone growth and lead to Ca²⁺ consumption, paradoxically causing hypocalcemia
Immobilization - prolonged immobilization leads to bone breakdown and the release of Ca²⁺
Multiple myeloma - a cancerous disease of B-lymphocytes, B-lymphocytes proliferate in the bones and break down Ca²⁺
Excess vitamin D - vitamin D increases Ca²⁺ resorption in the intestine
Sarcoidosis - substances with functions similar to vitamin D are formed
Hyperparathyroidism - in the parathyroid glands there is overproduction of parathyroid hormone, which breaks down Ca²⁺ from the bones
Chronic kidney disease - hyperparathyroidism develops

ECG and Hypercalcemia

ECG changes in hypercalcaemia, hypocalcaemia

Main feature:

Shortened QT interval

Secondary features:

Osborn wave (occurs in severe hypercalcemia)

Often creates a notch at the end of the QRS complex
Sometimes can mimic ST elevation (STEMI myocardial infarction)

The ascending part of the T wave is steeper than the descending part

In severe hypercalcemia ( Ca²⁺ > 3.4 mmol/l ) the risk includes:

Ventricular fibrillation

ECG Curve and Minerals

Hyperkalemia enlarges the T wave
Hypokalemia reduces the T wave
Hypercalcemia shortens the QT interval
Hypocalcemia prolongs the QT interval

ECG changes hypercalcemia, hypocalcemia, hyperkalemia, hypokalemia, T wave, QT interval

Hypercalcemia ( 3.7 mmol/l )

Shortened QT interval ( QT_c: 0.33s )
Osborn wave (V2-V5)

Notch at the end of QRS

Junctional rhythm

Heart rate: 50/min.
P waves are not visible

Hypercalcemia ( 4.1 mmol/l )

Borderline shortened QT interval ( QT_c: 0.36s )
Osborn waves (marked with arrows)

Notch at the end of QRS

Sinus rhythm

ECG hypercalcemia, high calcium level 6,1mmol/l, short QT interval, J - Osborn wave with notch

Hypercalcemia ( 6.1 mmol/l )

Borderline shortened QT interval ( QT_c: 0.35s )
Osborn wave ( "notch" in V1 )
The case involved a 41-year-old patient with hyperparathyroidism, who experienced ventricular fibrillation shortly after this ECG

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers

Home /

Hypercalcemia

Hypercalcaemia, Hypercalcemia, High calcium level

Calcium (Calcium, Ca²⁺)
Causes of Hypercalcemia
ECG and Hypercalcemia
ECG Curve and Minerals

Calcium (Calcium, Ca²⁺)

Calcium is mainly responsible for repolarization of the action potential
Physiological concentration is 2.1 - 2.6 mmol/l
Hypercalcemia has 3 stages:

Mild ( 2.7 - 2.9 mmol/l ) hypercalcemia
Moderate ( 3.0 - 3.4 mmol/l ) hypercalcemia
Severe ( > 3.4 mmol/l ) hypercalcemia

Calcium is mainly found in:

Milk, cheese, and yogurt

Causes of Hypercalcemia

Most common causes of hypercalcemia

Bone metastases break down Ca²⁺ from the bone, e.g., breast carcinoma. However, metastases in prostate carcinoma support bone growth and lead to Ca²⁺ consumption, paradoxically causing hypocalcemia
Immobilization - prolonged immobilization leads to bone breakdown and the release of Ca²⁺
Multiple myeloma - a cancerous disease of B-lymphocytes, B-lymphocytes proliferate in the bones and break down Ca²⁺
Excess vitamin D - vitamin D increases Ca²⁺ resorption in the intestine
Sarcoidosis - substances with functions similar to vitamin D are formed
Hyperparathyroidism - in the parathyroid glands there is overproduction of parathyroid hormone, which breaks down Ca²⁺ from the bones
Chronic kidney disease - hyperparathyroidism develops

ECG and Hypercalcemia

Main feature:

Shortened QT interval

Secondary features:

Osborn wave (occurs in severe hypercalcemia)

Often creates a notch at the end of the QRS complex
Sometimes can mimic ST elevation (STEMI myocardial infarction)

The ascending part of the T wave is steeper than the descending part

In severe hypercalcemia ( Ca²⁺ > 3.4 mmol/l ) the risk includes:

Ventricular fibrillation

ECG Curve and Minerals

Hyperkalemia enlarges the T wave
Hypokalemia reduces the T wave
Hypercalcemia shortens the QT interval
Hypocalcemia prolongs the QT interval

Hypercalcemia ( 3.7 mmol/l )

Shortened QT interval ( QT_c: 0.33s )
Osborn wave (V2-V5)

Notch at the end of QRS

Junctional rhythm

Heart rate: 50/min.
P waves are not visible

Hypercalcemia ( 4.1 mmol/l )

Borderline shortened QT interval ( QT_c: 0.36s )
Osborn waves (marked with arrows)

Notch at the end of QRS

Sinus rhythm

Hypercalcemia ( 6.1 mmol/l )

Borderline shortened QT interval ( QT_c: 0.35s )
Osborn wave ( "notch" in V1 )
The case involved a 41-year-old patient with hyperparathyroidism, who experienced ventricular fibrillation shortly after this ECG

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers

Hypercalcemia

Calcium (Calcium, Ca2+)

Causes of Hypercalcemia

ECG and Hypercalcemia

ECG Curve and Minerals

Hypercalcemia

Calcium (Calcium, Ca2+)

Causes of Hypercalcemia

ECG and Hypercalcemia

ECG Curve and Minerals

Calcium (Calcium, Ca²⁺)

Calcium (Calcium, Ca²⁺)