Images in Clinical Medicine
Electrocardiographic Changes of Hyperkalemia
N Engl J Med 1998; 338:662March 5, 1998
- Article
Figure 1 A 42-year-old woman with end-stage renal disease from recurrent nephrolithiasis was admitted to the hospital for placement of an arteriovenous fistula for permanent hemodialysis access. While she was undergoing dissection of the brachial artery with local anesthesia, her heart rhythm converted from normal sinus rhythm to complete heart block with a ventricular escape (approximately 25 beats per minute) (Panel A). Two ampules of calcium gluconate (9.2 mEq) were administered intravenously. An electrocardiogram revealed sinus tachycardia with profound prolongation of the QRS interval (left-bundle-branch morphology), first-degree atrioventricular block, and “peaked” T waves (Panel B). The serum potassium concentration was 8.6 mmol per liter. After correction of the serum potassium concentration, the electrocardiogram showed sinus rhythm with normalization of the PR and QRS intervals. Anteroseptal ST-wave and T-wave changes were noted on subsequent electrocardiograms (Panel C). A cardiac exercise imaging study did not show ischemia.
Jeffrey T. Kuvin, M.D.
New England Medical Center, Boston, MA 02111- Citing Articles (3)
Citing Articles
1
A. Calvo Elipe, J.P. Robles Ruiz, M.A. Sotto Claudet, J.L. Rodríguez Calderón. (2011) Alteraciones hidroelectrolíticas en Urgencias. Medicine - Programa de Formación Médica Continuada Acreditado 10:90, 6103-6113
CrossRef2
Kalev Freeman, James A. Feldman, Patricia Mitchell, Jacqueline Donovan, K. Sophia Dyer, Laura Eliseo, Laura Forsberg White, Elizabeth S. Temin. (2008) Effects of Presentation and Electrocardiogram on Time to Treatment of Hyperkalemia. Academic Emergency Medicine 15:3, 239-249
CrossRef3
G. Jarava Rol, M. Melero Bascones, J. Llabrés Díaz, L. Pallás. (2007) Alteraciones hidrosalinas en Urgencias. Medicine - Programa de Formación Médica Continuada Acreditado 9:88, 5686-5695
CrossRef
