Arjun Khadilkar, MD Profile picture
Cardiology fellow @IUcardsfellows 🫀| Interested in Prevention and Medical Education | Via @USFIMres @UToledoMed @cwru | Husband to @salonijairdn|

May 3, 2023, 11 tweets

One of the most important diagnostic tests in Cardiology to interpret is the EKG. Here are my thoughts and notes.

Let me know what you think!

Thread #18: Electrolyte Abnormalities #arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG

Hyperkalemia:
- Distinctive sequence of ECG changes affecting both depolarization (QRS) and repolarization (ST-T)
- First change: Narrowing and peaking of T-waves ('tented' or 'pinched' shape) and can become tall

Hyperkalemia:
- Further elevation: PR intervals become prolonged, P-waves may disappear. Will have intra-ventricular conduction delay, with widening of QRS complexes.
- Can lead to large, undulating (sine wave) pattern with asystole and cardiac death

Hyperkalemia ECG:
- Nice example from Life in the Fast Lane (litfl.com/hyperkalaemia-…)
- Can see: prolonged PR interval, broad QRS, and peaked T-waves

Hypokalemia:
- Produces distinctive changes in the ST-T complex; most common with ST-depressions with prominent U-waves and prolong repolarization
- U-waves may even exceed the height of the T-waves
- Can be challenging to measure the QT intervals

Hypokalemia EKG:
- Nice EKG from Life in the Fast Lane (litfl.com/hypokalaemia-e…)
- Note: Widespread ST depression and T wave inversion, Prominent U waves, Long QU interval
- Reported K~1.7

Hypercalcemia:
- Shortened QT interval is due to shortening of ST-segment.
- T-waves may appear to take off from the end of the QRS complex
- High Calcium can lead to coma/ death

Hypercalcemia EKG:
- Nice EKG from Life in the Fast Lane (litfl.com/hypercalcaemia…)
- Note hypercalcemia causing marked shortening of the QT interval (260ms)

Hypocalcemia:
- Lengthens or prolongs the QT intervals
- Example of a patient with prolonged QTc in the setting of hypoparathyoidism

Hypomagnesemia:
- Can be attributed to GI or renal losses (diuretic)
- Implicated in ventricular arrhythmias with acute MI and Torsade de Points
- Should have aggressive IV Magnesium replacement if needed
- EKG (litfl.com/hypomagnesaemi…) with an example of NSVT

***Not to use for clinical care, just educational material**

Thanks to these websites for the amazing graphics!

litfl.com/hyperkalaemia-…
litfl.com/hypokalaemia-e…
litfl.com/hypocalcaemia-…
litfl.com/hypercalcaemia…
litfl.com/hypomagnesaemi…

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