electrolyte changes: effects on the cardiovascular system

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1

hypokalemia

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  • less than 3mEq/L considered critical
  • changes may be subtle or pronounced
  • impairs myocardial conduction and prolongs ventricular depolarization
2

common causes of hypokalemia

  • diuretic therapy without replacement (furosemide)
  • GI losses
  • chronic corticosteroid use
3

hypokalemia change in ST segment

depressed ST segment

4

hypokalemia change in U wave

Prominent U wave

5

QT changes in hypokalemia

prolonged QT interval

6

PVCs caused by hypokalemia can deteriorate to

V-FIB or V-TACH

7

hyperkalemia

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  • serum level above 4.5mEq/L
  • results in decreased AV conduction, slowed ventricular depolarization, and accelerated depolarization
8

common causes of hyperkalemia

  • excess KCL administration
  • rhabdomylosis
  • tumor lysis syndrome
  • renal failure
9

T wave changes in hyperkalemia

tall, peaked, narrow, tent-like

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R wave changes in hyperkalemia

diminished height or amplitude

11

P waves changes in hyperkalemia

small or low amplitude

12

QRS changes in hyperkalemia

widened in severe cases

13

characteristics EKG features in hyperkalemia

  • wide complex tachycardia (serum level > 8mEq/L
  • heart block and Asystole
14

hypocalcemia

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  • serum total below 8.6mg/dl
  • results in decreased myocardial contractility, decreased CO, hypotension
15

EKG changes associated with low Ca seen in the ST segment of cardiac cycle

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  • lengthening or prolongation of ST segment
  • ST segment appears flat (isoelectric) and prolonged
  • prolong QTc interval
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potential rhythm disturbances in hypocalcemia

  • ranges from bradycardia to VT and Asystole
  • torsades de pointes (multifocal/polymorphic V tach)
17

hypercalcemia

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  • serum total level greater than 10.5mg/dl
  • causes increased contractility of the heart and shorted ventricular depolarization
18

T wave, QTc and ST segment changes in hypercalcemia

  • may note T wave immediately following QRS
  • QTC interval shortened
  • often absent
19

potential rhythm disturbances in hypercalcemia

  • bradycardia
  • 1st, 2nd or 3rd degree heart block
  • bundle branch blocks`
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common causes hypercalcemia

  • bone tumors
  • primary hyperparathyroidism
  • excessive supplementation (antacids)
  • hypomagnesemia and renal failure
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hypomagnesemia

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  • serum Mg level below 1.5mEq/L
  • delays ventricular depolarization
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common causes of hypomagnesemia

  • alterations in K, Ca, and pH
  • loop diuresis, diarrhea, vomiting
  • gastric suction, blood product administration (citrate chelation)
  • PPI use, ETOH abuse
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EKG changes in hypomagnesemia

  • PR and QTc intervals
  • U wave
  • T wave
  • QRS
  • prolonged PR and QTc intervals
  • U wave presence
  • T wave flattening
  • Widening QRS complexes
24

potential dysrhythmias associated with hypomagnesemia

V-tach with torsades de pointes

25

hypermagnesemia

  • serum level above 2.5mEq/L
  • rare occurence
26

common causes of hypermagnesemia

  • renal failure, tumor lysis syndrome
  • iatrogenic over treatment