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Hyperkalaemia

Hyperkalaemia, Hyperkalemia, High potassium level

Potassium (K⁺)
Causes of Hyperkalemia
ECG and Hyperkalemia
K⁺ > 5.6 mmol/l
K⁺ > 6.5 mmol/l
K⁺ > 7 mmol/l
K⁺ > 9 mmol/l
K⁺ > 20 mmol/l (Cardioplegic Solution)
Cardioplegia
Pseudoinfarction and Hyperkalemia

Potassium (K⁺)

Potassium is the main intracellular cation
Physiological concentration is 3.4 - 5.6 mmol/l
Hyperkalemia has 3 degrees:

Mild (5.6-6 mmol/l) hyperkalemia
Moderate (6-7 mmol/l) hyperkalemia
Severe (>7 mmol/l) hyperkalemia

Hyperkalemia

Slows conduction through the conduction system (negative dromotropy)
Suppresses the SA and AV nodes (negative chronotropy)

Potassium is mainly found in

Bananas, potatoes, beans

Causes of Hyperkalemia

Most common causes of hyperkalemia

Infusions with potassium
Blood transfusions that stand for a long time; red blood cells start to break down, releasing K⁺
With a change in pH by 0.1, the potassium level changes by approximately 0.5 mmol/l. With a decrease in pH - potassium rises, and vice versa
Kidney failure, resulting in impaired secretion of K⁺ into the urine
Cell breakdown in the body (hemolysis, tumor lysis); potassium is released into the blood from the broken-down cells
Medications (e.g., Spironolactone)

ECG and Hyperkalemia

ECG hyperkalemia, normal, moderate, severe hyperkalemia, peaked T waves, sine wave

With increasing hyperkalemia, the following develop gradually:

Peaked T waves mainly in the precordial leads

Often higher than R waves
(resembling the Eiffel Tower)

Wide QRS complexes

Gradually develops into a sine wave

With hyperkalemia > 9mmol/l there is a risk of:

The ECG curve does not always precisely correlate with potassium levels

K⁺ > 5.6 mmol/l

ECG hyperkalemia, peaked T waves, Eiffel Tower

High peaked T waves (Main sign)

Often higher than R waves
(resembling the Eiffel Tower)

Secondary signs:

Shortened QT interval

K⁺ > 6.5 mmol/l

ECG hyperkalemia, prolonged QRS complex, AV block, sine wave

Wide QRS complexes (Main sign)
Secondary signs:

In the presence of wide QRS complexes, always consider hyperkalemia

K⁺ > 7 mmol/l

ECG high potassium, hyperkalemia, hyperkalaemia, sine wave

Wide QRS complexes without P waves (Main sign)
Secondary signs:

K⁺ > 9 mmol/l

ECG sine wave, hyperkalemia, pre-terminal rhythm

Sine wave (Main sign)

Sine wave is the graph of the sine function

Secondary signs:

ECG ventricular fibrillation, hyperkalemia

Ventricular Fibrillation and Hyperkalemia

Potassium levels do not always correlate with the EKG appearance

Patients with relatively normal EKGs may have extreme hyperkalemia
And are at risk of ventricular fibrillation or even asystole

On the EKG, there is Ventricular Fibrillation

Frequency approximately 350/min.
Irregular low-amplitude QRS complexes
Untreated fibrillation may progress to asystole in about 2 minutes

K⁺ > 20 mmol/l (Cardioplegic Solution)

ECG cardiac arrest - asystole due to hyperkalemia, high serum potassium level

Cardioplegic Solution

Contains potassium concentration of: 20 - 30mmol/l

Cardioplegia

Is a planned temporary cessation of the heart
During cardiac surgical procedures

Cardioplegia

Hypothermic Cardioplegia

Is a perioperative method for protecting the myocardium from ischemia
Extremely high potassium concentration of 20 - 30mmol/l
- induces asystole during diastole

Application of the cardioplegic solution:

Flow through the aorta and the caval veins is interrupted using clamps
Then, the cardioplegic solution is applied to the aorta (anterogradely)
Large cannulas in the vena cava and aorta

are connected to the extracorporeal circulation

Pseudoinfarction and Hyperkalemia

Hyperkalemia sometimes in precordial leads (V1-2) mimics ST elevation

It can simulate a Septal STEMI myocardial infarction
Of course, the elevations disappear after potassium correction

ECG pseudoinfarction pattern Due to hyperkalemia, ST elevation

Hyperkalemia (7.1mmol/l)

In limb leads (I, II, III, aVR, aVF, aVL), the ECG curve resembles a sine wave
ST elevations (V1-V2)

The patient had hyperkalemia (7.1mmol/l), not a septal STEMI

ECG hyperkalemia eiffel tower, peaked T waves, potassium level 6,5 mEq/L

Hyperkalemia (6.5 mmol/l)

Tall, peaked T waves

They resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (leads V1-2)

ECG hyperkalemia 7,3 mEq/L, peaked T waves, first degree AV block, broad QRS, flattened T waves

Hyperkalemia (7.3 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (leads V1-4, II, III, aVR, aVF)

Wide QRS complexes (0.28s)
AV block I°

Prolonged PQ interval (0.4s)

Flat P waves
After correction of hyperkalemia, the ECG normalized to sinus rhythm

ECG hyperkalemia potassium level 7mEq/l, tall T waves

Hyperkalemia (7 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)
In the inferior leads (II, III, aVF), T waves resemble the QRS complex

ECG hyperkalemia potassium level 9,2 mEq/L, peaked T waves, broad QRS complexes, sine wave

Hyperkalemia (9.2 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)

Wide QRS complexes (0.2s)

In lead I and aVR, they resemble a sine wave

ECG hyperkalemia potassium level 9 mEq/L, peaked T waves - Eiffel tower, prolonged QRS, sine wave

Hyperkalemia (9 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)

Wide QRS complexes (approximately 0.24s)

Resemble a sine wave (T waves and QRS complexes become harder to differentiate)

P waves are not distinguishable
The patient had hyperkalemia due to rhabdomyolysis following severe physical exertion

ECG sine wave, hyperkalemia, potassium level 9,9 mEq/L, peaked T waves, broad prolonged QRS complexes

Hyperkalemia (9.9 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)

Wide QRS complexes (approximately 0.38s)

Resemble a sine wave

P waves are not distinguishable

ECG potassium level 7 mEq/L, peaked T waves, Eiffel tower, bradycardia, junctional rhythm

Hyperkalemia (7 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)

P waves are not distinguishable
Junctional rhythm

Heart rate: 35/min.

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 /

Hyperkalaemia

Hyperkalaemia, Hyperkalemia, High potassium level

Potassium (K⁺)
Causes of Hyperkalemia
ECG and Hyperkalemia
K⁺ > 5.6 mmol/l
K⁺ > 6.5 mmol/l
K⁺ > 7 mmol/l
K⁺ > 9 mmol/l
K⁺ > 20 mmol/l (Cardioplegic Solution)
Cardioplegia
Pseudoinfarction and Hyperkalemia

Potassium (K⁺)

Potassium is the main intracellular cation
Physiological concentration is 3.4 - 5.6 mmol/l
Hyperkalemia has 3 degrees:

Mild (5.6-6 mmol/l) hyperkalemia
Moderate (6-7 mmol/l) hyperkalemia
Severe (>7 mmol/l) hyperkalemia

Hyperkalemia

Slows conduction through the conduction system (negative dromotropy)
Suppresses the SA and AV nodes (negative chronotropy)

Potassium is mainly found in

Bananas, potatoes, beans

Causes of Hyperkalemia

Most common causes of hyperkalemia

Infusions with potassium
Blood transfusions that stand for a long time; red blood cells start to break down, releasing K⁺
With a change in pH by 0.1, the potassium level changes by approximately 0.5 mmol/l. With a decrease in pH - potassium rises, and vice versa
Kidney failure, resulting in impaired secretion of K⁺ into the urine
Cell breakdown in the body (hemolysis, tumor lysis); potassium is released into the blood from the broken-down cells
Medications (e.g., Spironolactone)

ECG and Hyperkalemia

With increasing hyperkalemia, the following develop gradually:

Peaked T waves mainly in the precordial leads

Often higher than R waves
(resembling the Eiffel Tower)

Wide QRS complexes

Gradually develops into a sine wave

With hyperkalemia > 9mmol/l there is a risk of:

The ECG curve does not always precisely correlate with potassium levels

K⁺ > 5.6 mmol/l

High peaked T waves (Main sign)

Often higher than R waves
(resembling the Eiffel Tower)

Secondary signs:

Shortened QT interval

K⁺ > 6.5 mmol/l

Wide QRS complexes (Main sign)
Secondary signs:

In the presence of wide QRS complexes, always consider hyperkalemia

K⁺ > 7 mmol/l

Wide QRS complexes without P waves (Main sign)
Secondary signs:

K⁺ > 9 mmol/l

Sine wave (Main sign)

Sine wave is the graph of the sine function

Secondary signs:

Ventricular Fibrillation and Hyperkalemia

Potassium levels do not always correlate with the EKG appearance

Patients with relatively normal EKGs may have extreme hyperkalemia
And are at risk of ventricular fibrillation or even asystole

On the EKG, there is Ventricular Fibrillation

Frequency approximately 350/min.
Irregular low-amplitude QRS complexes
Untreated fibrillation may progress to asystole in about 2 minutes

K⁺ > 20 mmol/l (Cardioplegic Solution)

Cardioplegic Solution

Contains potassium concentration of: 20 - 30mmol/l

Cardioplegia

Is a planned temporary cessation of the heart
During cardiac surgical procedures

Cardioplegia

Hypothermic Cardioplegia

Is a perioperative method for protecting the myocardium from ischemia
Extremely high potassium concentration of 20 - 30mmol/l
- induces asystole during diastole

Application of the cardioplegic solution:

Flow through the aorta and the caval veins is interrupted using clamps
Then, the cardioplegic solution is applied to the aorta (anterogradely)
Large cannulas in the vena cava and aorta

are connected to the extracorporeal circulation

Pseudoinfarction and Hyperkalemia

Hyperkalemia sometimes in precordial leads (V1-2) mimics ST elevation

It can simulate a Septal STEMI myocardial infarction
Of course, the elevations disappear after potassium correction

Hyperkalemia (7.1mmol/l)

In limb leads (I, II, III, aVR, aVF, aVL), the ECG curve resembles a sine wave
ST elevations (V1-V2)

The patient had hyperkalemia (7.1mmol/l), not a septal STEMI

Hyperkalemia (6.5 mmol/l)

Tall, peaked T waves

They resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (leads V1-2)

Hyperkalemia (7.3 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (leads V1-4, II, III, aVR, aVF)

Wide QRS complexes (0.28s)
AV block I°

Prolonged PQ interval (0.4s)

Flat P waves
After correction of hyperkalemia, the ECG normalized to sinus rhythm

Hyperkalemia (7 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)
In the inferior leads (II, III, aVF), T waves resemble the QRS complex

Hyperkalemia (9.2 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)

Wide QRS complexes (0.2s)

In lead I and aVR, they resemble a sine wave

Hyperkalemia (9 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)

Wide QRS complexes (approximately 0.24s)

Resemble a sine wave (T waves and QRS complexes become harder to differentiate)

P waves are not distinguishable
The patient had hyperkalemia due to rhabdomyolysis following severe physical exertion

Hyperkalemia (9.9 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)

Wide QRS complexes (approximately 0.38s)

Resemble a sine wave

P waves are not distinguishable

Hyperkalemia (7 mmol/l)

Tall, peaked T waves

Resemble the Eiffel Tower
Always consider hyperkalemia if T waves are higher than R waves (in almost all leads)

P waves are not distinguishable
Junctional rhythm

Heart rate: 35/min.

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

Hyperkalaemia

Potassium (K+)

Causes of Hyperkalemia

ECG and Hyperkalemia

K+ > 5.6 mmol/l

K+ > 6.5 mmol/l

K+ > 7 mmol/l

K+ > 9 mmol/l

K+ > 20 mmol/l (Cardioplegic Solution)

Cardioplegia

Pseudoinfarction and Hyperkalemia

Hyperkalaemia

Potassium (K+)

Causes of Hyperkalemia

ECG and Hyperkalemia

K+ > 5.6 mmol/l

K+ > 6.5 mmol/l

K+ > 7 mmol/l

K+ > 9 mmol/l

K+ > 20 mmol/l (Cardioplegic Solution)

Cardioplegia

Pseudoinfarction and Hyperkalemia

Potassium (K⁺)

K⁺ > 5.6 mmol/l

K⁺ > 6.5 mmol/l

K⁺ > 7 mmol/l

K⁺ > 9 mmol/l

K⁺ > 20 mmol/l (Cardioplegic Solution)

Potassium (K⁺)

K⁺ > 5.6 mmol/l

K⁺ > 6.5 mmol/l

K⁺ > 7 mmol/l

K⁺ > 9 mmol/l

K⁺ > 20 mmol/l (Cardioplegic Solution)