ECG changes in Hypokalemia& hyperkalemia

Electrocardiogram (ECG) changes are commonly observed in both hypokalemia (low potassium levels) and hyperkalemia (high potassium levels), reflecting the effects of potassium imbalance on cardiac electrical activity.

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Here are the typical ECG changes associated with each condition:

**Hypokalemia (Low Potassium Levels):**

1. **Flattened or Inverted T Waves**: Hypokalemia may cause flattening or inversion of the T waves on the ECG. The T wave represents ventricular repolarization, and alterations in its morphology are characteristic of hypokalemia.

• **U Wave**: In severe hypokalemia, an additional wave called the U wave may appear after the T wave. The U wave is believed to represent repolarization of the Purkinje fibers and is typically seen in leads V2-V4.

• **ST Segment Depression**: ST segment depression may occur in hypokalemia, particularly in leads with prominent T wave changes. ST segment depression may be seen along with T wave changes, reflecting abnormalities in ventricular repolarization.

• **Increased P Wave Amplitude**: Hypokalemia may lead to increased P wave amplitude, resulting in tall, peaked P waves. This can be observed particularly in leads II, III, and aVF.

• **Prolonged QT Interval**: Hypokalemia can prolong the QT interval on the ECG, increasing the risk of ventricular arrhythmias such as torsades de pointes.

**Hyperkalemia (High Potassium Levels):**

1. **Peaked T Waves**: Hyperkalemia is often associated with tall, peaked T waves on the ECG. These T waves may be narrow or tent-shaped and can be observed in multiple leads.

• **PR Interval Prolongation**: Hyperkalemia may prolong the PR interval on the ECG, reflecting delayed atrioventricular conduction. This can be observed as a gradual prolongation of the PR interval before the QRS complex.

• **Loss of P Waves**: In severe hyperkalemia, the P waves may become less distinct or even disappear, leading to a “sinusoidal” pattern. This reflects impaired atrial depolarization due to high potassium levels.

• **Wide QRS Complex**: Severe hyperkalemia can cause widening of the QRS complex on the ECG, indicating impaired ventricular depolarization. This can progress to conduction abnormalities such as bundle branch blocks or ventricular arrhythmias.

• **ST Segment Changes**: Hyperkalemia may cause ST segment changes, including elevation or depression, particularly in conjunction with other ECG abnormalities such as peaked T waves or widened QRS complexes.

It’s important to note that the severity and specific ECG changes associated with hypokalemia or hyperkalemia can vary depending on factors such as the rate of onset, unde

rlying cardiac conditions, and concurrent electrolyte imbalances. Prompt recognition and appropriate management of potassium disturbances are essential to prevent cardiac complications and improve patient outcomes.