ECG Question

suzanne4, RN · Aug 27, 2005

Yes............not everyone places their electrodes in the same place, first of all. So you always want to do a double check.........

suzanne4, RN · Aug 27, 2005

You want to verify all of the leads that have the elevation. 5 leads will not give you a complete report.

SEOBowhntr · Sep 9, 2005

Not sure what the real question is here??? Are you asking if you must do a 12 Lead to see EKG changes associated with Electrolyte imbalances, or to determine Ischemic changes??? If you are speaking only pertaining to electrolyte imbalances, generally you do not need a 12 Lead, if you are talking about determining whether or not you have Ischemic changes, yes, you need a 12 Lead for a complete picture.

Doug

candyndel · Sep 12, 2005

Which electrolyte imbalances cause ST elevations?

You want to verify all of the leads that have the elevation. 5 leads will not give you a complete report.

Jubei · Sep 15, 2005

Low K+ Causes ST abnormalities along with say...carbon monoxide poisoning.

candyndel · Sep 15, 2005

ST depression yes, but I was asking about elevation...

Low K+ Causes ST abnormalities along with say...carbon monoxide poisoning.

Jubei · Sep 23, 2005

ST depression yes, but I was asking about elevation...

Okay, think for a moment here. If low K+ causes ST depression, what do you think high K+ will do to a person's ST?

High K+ also causes wide QT's.

candyndel · Sep 23, 2005

Thanks for being so kind, but I have never heard of hyperkalemia as a differential for ST elevation. Pericarditis, myocardial infarction, coronary vasospasms, even early repolarization, yes. Nor can I locate a resource that notes the same J point effects, as described.

I also didn't know electrical changes occur in equal opposition.

Okay, think for a moment here. If low K+ causes ST depression, what do you think high K+ will do to a person's ST?
High K+ also causes wide QT's.

Jubei · Sep 24, 2005

Thanks for being so kind, but I have never heard of hyperkalemia as a differential for ST elevation. Pericarditis, myocardial infarction, coronary vasospasms, even early repolarization, yes. Nor can I locate a resource that notes the same J point effects, as described.
I also didn't know electrical changes occur in equal opposition.

Google it ! You'll find the answers. :)

papawjohn · Sep 24, 2005

Hey Y'all

I didn't think s-t SEGMENTs were altered by K+ ups & downs. Anyhow, quickly googled and was led to this:

Hyper K:

level around 6-QRS complex widens and may merge with T-wave resulting in "sine-wave"

6.5-P waves begin to flatten and widen...this effect tends to reverse if K+ increases greater than 7

>7-may lead to sinus arrest

>10-cardiac standstill

Hypo K:

level around 3-QRS widens...ST Segment may be depressed and Twave may flatten

"the consultant pharmacist" http://www.ascp.com/public/pubs/tcp/1997/jan/idicerei.html

Papaw John

Jubei · Sep 25, 2005

This is what I found (and from reading my med surg/ekg books):

Elevated Potassium can Produce Pseudo Heart Attack

When a man appeared in the Emory Hospital Emergency Department with nausea, vomiting and abdominal pain that had persisted for eight hours, an electrocardiogram (ECG) was performed. The test revealed an elevated ST-segment -- the tell-tale sign of a major heart attack (also called a myocardial infarction, or MI).

But this patient was only 20 years old. Was he really having a heart attack?

In an "Images in Cardiovascular Medicine Case Study" presented in the May 17th edition of the American Heart Association journal "Circulation", Emory physicians Laurence Sperling, MD, and Daniel B. Sims, MD, explain how their medical detective work showed the patient was having a "pseudo infarction". Instead of an actual MI, the man's cardiac and other symptoms were the result of hyperkalemia, defined as a serum potassium level greater than 5.3 millimols per liter(mmo/L).

"The ST-segment elevation on the ECG was so extreme that some people might have overlooked other findings which indicated a pseudo infarction' pattern caused by excess potassium," explains Dr. Sims, a resident physician in the Emory Department of Medicine. "But we also saw a widened QRS, peaked T waves, and absent P waves on the ECG and those findings are not seen in heart attacks. This helped tip us off that the patient was in serious trouble because of hyperkalemia."