Download - Effect of electrolytes on cardiac rhythm
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EFFECT OF ELECTROLYTES ON CARDIAC RHYTHM
Prepared by: Ahmad Thanin
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OBJECTIVES:By the end of session learners will be able to:
• Define Electrolytes.• Discuss the function of electrolytes• Describe the relationship of electrolyte with
heart• List down common electrolytes
responsible for cardiac function• Explain the effect of electrolytes on heart• Interpret the ECG features of different
electrolyte imbalances• Summarize the main key points of the
session
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What are Electrolytes?
Chemically, electrolytes are substances that become ions in solution and acquire the capacity to conduct electricity. Electrolytes are present in the human body, and the balance of the electrolytes in our bodies is essential for normal function of our cells and our organs.
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FUNCTIONS:
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Electrolytes and Heart:
• The normal state of cardiac cell membrane polarization is dependent upon the maintenance of a normal ionic balance across the membranes
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Common Electrolytes responsible for cardiac arrhythmias
• Potassium• Magnesium• Calcium
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HYPERKALEMIA
Background•Potassium is vital for regulating the normal electrical activity of the heart.•Increased extracellular potassium reduces myocardial excitability, with depression of both pacemaking and conducting tissues.•Progressively worsening hyperkalemia leads to suppression of impulse generation by the SA node and reduced conduction by the AV node and His-Purkinje system, resulting in bradycardia and conduction blocks and ultimately cardiac arrest.
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ECG features of Hyperkalemia:
• Rhythm: Atrial and ventricular rhythms are regular• Rate: Atrial and ventricular rates are within normal limits• P Wave: Mild-low amplitude, moderate-wide flattened,
severe-indiscernible• PR interval: Normal or prolonged; unmeasureable if P
wave cant be detected• QRS complex: Widened because ventricular
depolarization takes longer• QT interval: Shortened • ST segment: May be elevated in severe hyperkalemia • T wave: Tall, Peaked.
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Peaked T waves in Hyperkalemia
Prolonged PR segment in Hyperkalemia
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Broad P waves and QRS complexes
Loss of P waves
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Bradycardia
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HYPOKALEMIA
Background•Potassium is vital for regulating the normal electrical activity of the heart•Decreased extracellular potassium causes myocardial hyper excitability with the potential to develop re-entrant arrhythmias
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ECG features of Hypokalemia:
• Rhythm: : Atrial and ventricular rhythms are regular• Rate: Atrial and ventricular rates are within normal limits• P Wave: Usually normal size and configuration • PR interval: May be prolonged • QRS complex: Within normal limits or possibly widened;
prolonged in hypokalemia• QT interval: Usually indiscernible as T wave flattens • ST segment: Depressed• T wave: Amplitude is decreased. Inverted T wave U
wave may appear.
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T inversion and prominent U wave in Hypokalemia
Long QT interval in Hypokalemia
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HYPOCALCEMIA
Background•Calcium is important in cardiac function; it exerts a positive inotropic effect on heart •Decreased calcium levels may cause decreased myocardial contraction.
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ECG features of Hypocalcaemia:
• Rhythm: Atrial and ventricular rhythms are regular• Rate: Atrial and ventricular rates are within normal limits• P Wave: Normal size and configuration• PR interval: Within normal limits• QRS complex: Within normal limits• QT interval: Prolonged• ST segment: Prolonged • T wave: Normal size and configuration, may be flattened
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Prolong QT interval in Hypocalcaemia
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HYPERCALCAEMIA
Background•Calcium is important in cardiac function; it exerts a positive inotropic effect on heart •Increased calcium levels may block the conduction pathways of electrical impulse.
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ECG features of Hypercalcemia:
• Rhythm: Atrial and ventricular rhythms are regular• Rate: Atrial and ventricular rates are within normal limits,
bradycardia or heart block may occur• P Wave: Normal size and configuration • PR interval: May be prolonged.• QRS complex: Within normal limits, may be prolonged • QT interval: Prolonged• ST segment: Normal• T wave: Normal size and configuration; may be
depressed.
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Shortened QT interval in Hypercalcemia
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HYPOMAGMESAEMIA
Background•Magnesium is required to support the heart muscle’s normal contraction-relaxation actions. •Decreased magnesium levels may cause irregular contraction of ventricles leading to arrhythmias.
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ECG features of Hypomagnesaemia:
• Rhythm: Irregular ventricular rhythm • Rate: Atrial and ventricular rates may be regular• P Wave: May be normal • PR interval: Normal • QRS complex: Normal• QT interval: Normal • ST segment: Depressed• T wave: Tall T waves
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Tall T waves in Hypomagnesaemia
Torsades de pointes
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Depressed ST segment in Hypomagnesaemia
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HYPERMAGMESAEMIA
Background•Magnesium is required to support the heart muscle’s normal contraction-relaxation actions. •Increased magnesium levels may cause delayed conduction of electrical impulse.
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ECG features of Hypermagnesemia
• Rhythm: Atrial or ventricular rhythm may be regular • Rate: Atrial and ventricular rates may be regular• P Wave: May be normal • PR interval: prolonged• QRS complex: Widened• QT interval: Normal• ST segment: Normal • T wave: Normal
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Prolonged PR interval in Hypermagnesemia
Wide QRS complex in Hypermagnesemia
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In a nut shell
Hypocalcaemia- Prolonged ST and QT intervals
Hyperkalemia- shortened ST segment- widened T wave
Hypokalemia- ST depression- shallow, flat, inverted T wave- Prominent U wave
Hyperkalemia- Tall, peaked T waves- Flat P waves- widened QRS complex- Prolonged PR interval
Hypomagnesaemia- Tall T waves- Depressed ST segment
Hypermagnesemia- Prolonged PR interval- widened QRS complexes
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Treatment:• Hyperkalemia Cocktail• Hypokalemia Potassium replacement• Hypercalcemia Magnesium• Hypocalcemia Calcium replacement• Hypermagnesemia Calcium replacement• Hypomagnesaemia Mg replacement