Hypoaldosteronism electrocardiogram
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
In hypoaldosteronism there are no specific ECG findings. However, hypoaldosteronism predisposes to hyponatremia (decreased renal absorption) and hyperkalemia (decreased renal excretion). Severe hyponatremia may present with ST segment elevation mimicking acute myocardial infarction. On the other hand, hyperkalemia leads to depression of SA node and conduction pathways such as AV node and His-Purkinje system causing bradycardia and conduction blocks.
Electrocardiogram
There are no specific ECG findings associated with hypoaldosteronism. However, hypoaldosteronism predisposes to hyponatremia (decreased renal absorption) and hyperkalemia (decreased renal excretion). An ECG must be obtained when the potassium level is more than 6.0 mEq/L.[1]
- Hyperkalemia leads to depression of SA node and conduction pathways such as AV node and His-Purkinje system. Findings on an ECG suggestive of hyperkalemia include:[2][3][4][5]
- Peaked T waves in chest leads.
- Widening of the QRS complex (seen with potassium level ≥ 6.5 mEq/L).
- Prolonged QRS interval and conduction blocks such as bundle branch blocks or fascicular blocks (seen with potassium level ≥ 7 mEq/L).
- Ventricular fibrillation, PEA and cardiac arrest (seen with potassium level ≥ 9 mEq/L).
- Hyponatremia may slow cardiac pacemaker activity. Findings on an ECG suggestive of hyponatremia include:[6][7]
- ST segment elevation mimicking acute myocardial infarction.
References
- ↑ Montague BT, Ouellette JR, Buller GK (2008). "Retrospective review of the frequency of ECG changes in hyperkalemia". Clin J Am Soc Nephrol. 3 (2): 324–30. doi:10.2215/CJN.04611007. PMC 2390954. PMID 18235147.
- ↑ Webster A, Brady W, Morris F (2002). "Recognising signs of danger: ECG changes resulting from an abnormal serum potassium concentration". Emerg Med J. 19 (1): 74–7. PMC 1725789. PMID 11777886.
- ↑ Rastegar A, Soleimani M, Rastergar A (2001). "Hypokalaemia and hyperkalaemia". Postgrad Med J. 77 (914): 759–64. PMC 1742191. PMID 11723313.
- ↑ Diercks DB, Shumaik GM, Harrigan RA, Brady WJ, Chan TC (2004). "Electrocardiographic manifestations: electrolyte abnormalities". J Emerg Med. 27 (2): 153–60. doi:10.1016/j.jemermed.2004.04.006. PMID 15261358.
- ↑ Humphreys M (2007). "Potassium disturbances and associated electrocardiogram changes". Emerg Nurse. 15 (5): 28–34. doi:10.7748/en2007.09.15.5.28.c4252. PMID 17902552.
- ↑ Alvarez PA, Vázquez Blanco M, Lerman J (2011). "Brugada type 1 electrocardiographic pattern induced by severe hyponatremia". Cardiology. 118 (2): 97–100. doi:10.1159/000327089. PMID 21540589.
- ↑ Tamene A, Sattiraju S, Wang K, Benditt DG (2010). "Brugada-like electrocardiography pattern induced by severe hyponatraemia". Europace. 12 (6): 905–7. doi:10.1093/europace/euq034. PMID 20185483.