The QRS complexes would widen, and eventually a sine wave pattern may form. Think of severe hyperkalemia as grabbing on to each end of the EKG tracing and pulling outward to stretch it out. Lastly, we will move counterclockwise to the arrow pointing right.Īs potassium levels continue to rise, the next EKG change to develop is QRS widening.Ī widened QRS refers to QRS complexes that have a longer duration than normal. Since progressive atrial paralysis occurs at potassium levels of 6.5-7.0 mEq/L and the PR interval and P wave both involve the atria, we see changes to the PR interval and P wave morphology as a result. In other words, the PR interval is the time it takes for an electrical impulse to depolarize the atria and travel through the atria and AV node to the ventricles. Remember from our EKG lecture the P wave represents atrial depolarization, and the PR interval represents the time from the start of the P wave (atrial depolarization) to the start of the QRS complex (ventricular depolarization). PR interval prolongation and P wave widening typically occur at potassium levels of 6.5-7.0 mEq/L.Īgain, this is not a hard-and-fast rule but just an average.Īt potassium levels of 6.5-7.0 mEq/L, progressive atrial paralysis can occur. The left arrow will help you remember the prolonged durations associated with the PR interval and P wave. P wave widening refers to P waves that have a longer duration than normal. PR interval prolongation refers to a longer than normal duration between the start of the P wave and the start of the QRS complex. The next EKG changes to develop are PR interval prolongation and P wave widening. The arrow trick moves in a counterclockwise direction and illustrates the progression of EKG changes in hyperkalemia.Īfter the up arrow, we move to the arrow pointing left. To learn more about depolarization and repolarization, check out the lecture on Cardiac Action Potentials Made Easy. Since repolarization abnormalities occur at potassium levels of 5.5-6.5 mEq/L and the T waves represent ventricular repolarization, we see changes to the T wave morphology as a result. If you need a quick refresher on the different components of an EKG, then make sure to check out the lecture on EKGs Made Easy. Remember from our EKG lecture that the T wave represents ventricular repolarization. Peaked T waves generally occur when potassium levels are about 5.5-6.5 mEq/L.Īgain, this is not a hard-and-fast rule and there may be peaked T waves outside that range.Īt potassium levels of 5.5-6.5 mEq/L, repolarization abnormalities can occur. The up arrow will help you remember peaked T waves. One of the first EKG changes to occur in hyperkalemia is peaked T waves.Ī peaked T wave refers to a T wave with a higher than normal amplitude that gives a tall, peaked or tented appearance. Since we are dealing with increased levels of potassium, this will help you remember to start with the arrow pointing up. Simply think of hyperkalemia, which is elevated levels of potassium in the blood. How can you remember to start with the up arrow? The arrow trick begins with the up arrow. Therefore, hyperkalemia is defined as elevated levels of potassium in the blood. The term “kalemia” refers to the presence of potassium in the blood. We know from our medical terminology lecture that the prefix “ hyper” means above normal, excess, high, or elevated. The definition makes sense if we break down the word. Hyperkalemia is the medical term used to describe higher than normal potassium levels in the blood. Leave a comment down below if you find this trick useful! There is a table at the bottom of this post summarizing everything, so make sure to read until the end to not miss out! You will also learn a simple trick to remember these changes! In this lecture, we will review the main EKG changes that occur in hyperkalemia along with the mechanism behind those findings. Potassium is involved in cardiac conduction, which allows our heart to contract and pump blood forward.Ĭhanges to normal potassium levels in the blood can affect cardiac function.įor example, elevated potassium levels in the blood (hyperkalemia) can impact the cardiac conduction system, which can lead to changes seen on EKG. The heart is one organ in particular that relies on potassium to perform. Potassium plays an important role in the human body and is required for many cells to function properly.
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