Near-fatal arrhythmia caused by hyperkalaemia

Abstract

Objective: To evaluate and compare the risk of sudden cardiovascular death (SCD) and non-SCD after myocardial infarction (MI) associated with age and sex. Design: Cohort study of patients admitted with an enzyme verified acute MI and discharged alive. Patients were followed up for up to four years. Patients: 5983 consecutive hospital survivors of acute MI were enrolled in the TRACE (trandolapril cardiac evaluation) registry from 1990-92. Four age groups were prespecified: < 56, 56-65, 66-75, and > 76 years. Main outcome measures: SCD was defined as cardiovascular death within one hour of onset of symptoms.Results: There were 536 SCD and 725 non-SCD. SCD mortality was 4.8% in the youngest and 15.7% in the oldest age groups. Non-SCD mortality was 3.5% and 25%, respectively. The ratio of SCD to non-SCD mortality varied from 1.44 in the youngest (< 56 years) to 0.55 in the oldest patients (> 76 years). Age significantly increased both SCD and non-SCD risk (p < 0.0001), but the increase in non-SCD risk was 40% higher (p < 0.0001). Male sex was associated with increased risk of SCD independently of age (risk ratio 1.34, p < 0.005). However, the absolute three year probability of SCD among women older than 66 years exceeded 10%. Conclusions: Compared with non-SCD the risk of SCD is relatively highest in the younger age groups, but the absolute risk of SCD is much higher among the upper age groups than the younger. The risk of SCD was slightly lower in women but not enough to warrant a different treatment strategy.

Wide complex rhythm and cardiac arrest

“…As the potassium rises to 6.5-7.5 mmol/l, the PR interval lengthens and the P waves gradually widen, flatten, and eventually disappear completely. As potassium levels rise to Ͼ 7.0 mmol/l, the QRS begins to widen and eventually merges with the T wave, creating a sinusoidal pattern, which is terminal without immediate treatment (7,8). Finally, death from hyperkalemia results from several possible terminal rhythms such as asystole (more common with chronic hyperkalemia), PEA, or VF (7).…”

Arrhythmias and ECG changes in life threatening hyperkalemia in older patients treated by potassium sparing drugs

“…In severe hyperkalemia (serum potassium > 7.0 mmol/L), sinus bradycardia, widening and flattening of P waves, conduction disturbances with prolongation of PR interval, wider QRS complex, Tawar bundle branch blocks, atrioventricular blockades (blockade of sodium channels) and ectopic electric activity can by seen. Sporadically ST depression with T wave inversions or ST elevation which may mimic acute myocardial infarction have been described [24][25][26][27][28][29][30][31][32][33] . The most severe hyperkalemia is represented by disappearance of P waves and sinus rhythm is replaced by emergency junction or ventricular rhythm with bizarre shape QRS.…”

Die vitalbedrohliche Hyperkaliämie des Diabetikers - ein unterschätztes Risiko?

“…Consi− dering the differential diagnosis hyperkalemia during CPR delivery may also be relevant with re− spect to the possibly favourable outcome of this potentially reversible electrolyte disturbance. droms) bei akuter Hyperkaliämie beschrieben ist [4,5], geht die notfallmedizinisch relevante Vitalgefährdung häufig primär von einer (bradykarden) Herzrhythmusstörung aus [1, 6,7]. Kardiale Dekompensationen außerhalb der Klinik werden meist mit der Exazerbation einer vorbestehenden Grunderkrankung (z.…”