INTRODUCTION
- Various electrolyte disorders can result in abnormalities to the resting ECG ranging to clinically significant arrhythmias
- Hyperkalaemia is the commonest abnormality that can lead to significant arrhythymias
- General factors that predict deterioration are conduction abnormalities, QT changes and frequent ectopic beats
- Treatment of arrhythmias typically follow ACLS guidelines in combination with correction of the abnormality
Resting ECG Changes
| P wave | PR Interval | QRS duration | ST segment | T wave | QT interval | Other | |
| ↓K | ↓ | Flat/ Inverted | ↑
|
U wave | |||
| ↑K | +/0 | ←→ | Peaked | ↓ | Sine wave | ||
| ↓Ca | ↑
|
||||||
| ↑Ca | ←→ | ↑
→← |
Abrupt upslope
Flat/Inverted/Biphasic |
↓ | ↑ QRS size | ||
| ↓Mg | ←→ | ←→ | ↑
→← |
Peaked
Flat/Wide/Inverted
|
↑
|
U wave | |
| ↑Mg | |||||||
| ↑Li | Flat | Flat |
Arrhythmias
| Bradyarrythmias | Tachyarrythmias | |
| ↓K | Sinus Bradycardia 1o/2o AV block Asystole |
AF PAT SVT PACs PVCs VT VF |
| ↑K | 2o/3o AV block Asystole |
Broad complex tachycardia
VF |
| ↓Ca | Sinus Bradycardia | Torsade de pointes |
| ↑Ca | 2o/3o AV block Asystole |
SVT VT |
| ↓Mg | PACs PVCs AF MAT SVT PVCs VT Torsade de Pointes VF |
|
| ↑Mg | 3o AV block Asystole (diastolic arrest) |
|
| ↑Li | Sinus/Bradycardic arrest (rare) |
