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JAGDISH. K
PROF. DR. A. GOWRISHANKAR’S UNIT
ECG OF THE WEEK
30 yr old male was brought with the chief complaints of fever, altered sensorium for the past 3 days.
Patient was apparently alright 3 days ago.
Known type 1 diabetic on Insulin.
Examination
Patient was febrile, dyspneic, tachypneic, disoriented
Pulse : 110/minBP : 100/60 mm of hgRR : 38/minCNS :
disorientation + Neck rigidity +
Other systems : normal
ECG
ECG changes in electrolyte imbalance is not very predictable.
Change depends on the inter individual variation & on the other electrolytes too.
However certain ECG features often develop in conjunction with increased / decreased potassium concentration so that ECG may be frequently utilised for electrolyte disturbances particularly if the interpreter is thinking of electrolyte disturbances.
Accuracy of observation is enhanced if Control tracing available
Serial tracings done
Hyperkalemia
It has not been definitely established that the changes are due to
1. Intracellular K+ changes2. Gradient across cell membrane3. Potassium level in the serum alone
Action Potential
Atrial
SA Nodal
Ventricular
Similarities vs Differences
K+ changes & Action Potential curve
Changes during depolarisation & resting membrane potential
Changes during repolarisation
ECG changes
Short QT interval
Peaked T wave
ST segment depression
Lowering & widening of P wave
Prolonged PR interval
QRS widening
Short R wave & deep S wave
Marching of QRS & T wave towards each other
The Nadir of S wave & peak of T wave is connected by a straight line.
Sine wave pattern
Atrial fibrillation & Atrial arrest
Sinoventricular rhythm
Effect of other electrolytes
Low Na+ High Na+
Low Ca2+ High Ca2+
ECG
Sine wave