Dynamic Changes of EKG by Severe Hyperkalemia: Transient Left Bundle Branch Block

Abstract

Hyperkalemia is one of the most common electrolyte abnormalities seen in clinical practice and the most common life-threatening electrolyte abnormality seen in the emergency department. It is most often due to impaired renal potassium excretion due to acute on chronic kidney disease or the use of drugs that inhibit the renin-angiotensin-aldosterone axis. The most common clinical presentation is muscle weakness and cardiac conduction abnormalities. In the Emergency Department, ECG can come in handy as the first diagnosis of hyperkalemia before labs are drawn and reported. Early recognition of electrocardiographic (ECG) changes can prompt early correction and reduce mortality. We hereby, present a case of transient left bundle branch block in the setting of hyperkalemia secondary to statin-induced rhabdomyolysis.

Electrocardiographic Abnormalities in Patients with Hyperkalemia: A Retrospective Study in an Emergency Department in Colombia

“…Regarding treatment, the use of loop diuretics, beta-agonists, polarizing solutions, hemodialysis, insulin, and ion-exchange resins with an action potential stabilizer membrane with calcium gluconate has been described. 31 , 37 The alternatives in the treatments are associated with the severity of hyperkalemia, comorbidities, and chronicity.…”

“…Heart block rhythm has been documented in several case reports in patients with high serum potassium level which describe AV block or branch block AV node's susceptibility to hyperkalemia. [31][32][33] Varga et al described AV block in moderate (n: 10/97) and severe (n: 7/38). 13 This finding is more common in severe hyperkalemia.…”