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Hyperkalemia and Pacemaker

Hyperkalemia and pacemaker

ECG and Hyperkalemia
Hyperkalemia and Pacemaker

ECG and Hyperkalemia

ECG hyperkalemia level pattern

Hyperkalemia prolongs ventricular conduction of the impulse

Widens the QRS complex and the P wave

With increasing hyperkalemia, the following gradually develop:

Peaked T waves especially in precordial leads

Often higher than the R wave
(resembling the Eiffel Tower)

Wide QRS complexes

Gradually forming a sinusoidal pattern

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

ECG curve does not always precisely correlate with potassium levels

ECG pattern hyperkalemia, 9mmmol

Hyperkalemia (9 mmol/l)

Tall peaked T waves

Resembling the Eiffel Tower
Hyperkalemia is always suspected if T waves are higher than R waves (in almost all leads)

Wide QRS complexes (approximately 0.24s)

Resembling a sinusoidal pattern (T waves and QRS complexes are difficult to differentiate)

P waves cannot be differentiated
The patient had hyperkalemia due to rhabdomyolysis after severe physical exertion

Hyperkalemia and Pacemaker

Pacemaker and hyperkalemia

Hyperkalemia reduces myocardial response to pacing

Initially, the atria stop responding, followed by the ventricles
After stimulation, there is no P wave (QRS complex)

Pacemaker exit block I degree

Hyperkalemia prolongs pacemaker latency

There is slowed conduction of the impulse from the electrode through the myocardium

Pacemaker exit block I degree

There is a prolonged interval from stimulation to the start of depolarization

ECG pacemaker mode DDD (ApVp), hyperkalemia, pacemaker exit block 1st degree

DDD Pacemaker and Hyperkalemia (7.2 mmol/l)

The patient has an implanted DDD pacemaker

We can see stimulation of the atria and ventricles (ApVp)

After atrial pacing, there is no P wave

The atria do not respond to the pacemaker

Ventricular pacing is intermittently effective

Only every 3rd ventricular pacing produces a QRS complex

Pacemaker exit block of the 1st degree

There is a prolonged interval from stimulation to the start of depolarization (QRS)

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

Hyperkalemia and Pacemaker

Hyperkalemia and pacemaker

ECG and Hyperkalemia
Hyperkalemia and Pacemaker

ECG and Hyperkalemia

Hyperkalemia prolongs ventricular conduction of the impulse

Widens the QRS complex and the P wave

With increasing hyperkalemia, the following gradually develop:

Peaked T waves especially in precordial leads

Often higher than the R wave
(resembling the Eiffel Tower)

Wide QRS complexes

Gradually forming a sinusoidal pattern

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

ECG curve does not always precisely correlate with potassium levels

ECG hyperkalemia level pattern

ECG pattern hyperkalemia, 9mmmol

Hyperkalemia (9 mmol/l)

Tall peaked T waves

Resembling the Eiffel Tower
Hyperkalemia is always suspected if T waves are higher than R waves (in almost all leads)

Wide QRS complexes (approximately 0.24s)

Resembling a sinusoidal pattern (T waves and QRS complexes are difficult to differentiate)

P waves cannot be differentiated
The patient had hyperkalemia due to rhabdomyolysis after severe physical exertion

Hyperkalemia and Pacemaker

Hyperkalemia reduces myocardial response to pacing

Initially, the atria stop responding, followed by the ventricles
After stimulation, there is no P wave (QRS complex)

Pacemaker exit block I degree

Hyperkalemia prolongs pacemaker latency

There is slowed conduction of the impulse from the electrode through the myocardium

Pacemaker exit block I degree

There is a prolonged interval from stimulation to the start of depolarization

Pacemaker and hyperkalemia

ECG pacemaker mode DDD (ApVp), hyperkalemia, pacemaker exit block 1st degree

DDD Pacemaker and Hyperkalemia (7.2 mmol/l)

The patient has an implanted DDD pacemaker

We can see stimulation of the atria and ventricles (ApVp)

After atrial pacing, there is no P wave

The atria do not respond to the pacemaker

Ventricular pacing is intermittently effective

Only every 3rd ventricular pacing produces a QRS complex

Pacemaker exit block of the 1st degree

There is a prolonged interval from stimulation to the start of depolarization (QRS)

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