The electrocardiographic effects of alterations in concentration of plasma chemicals

Herndon, Richard F.; Meroney, William H.; Pearson, Carl M.

doi:10.1016/0002-8703(55)90315-x

Cited by 21 publications

(6 citation statements)

References 22 publications

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“…Sharpey-Schafer32 showed that T inversion due to heart strain, in contrast to that caused by myocardial infarction, can transiently be abolished by oral administration of potassium chloride, and Langendorf and Piranil7 were the first to point out that the T-wave configuration in spontaneous hyperkalemia and uremia is the result of a composite effect of several factors acting in opposite direction upon its amplitude and configuration. The combination of S-T elevation caused by uremic pericarditis with hyperkalemic T-wave contour, as illustrated in figure 3, was recognized previously4' 17, 21 and its reversibility by dialysis demonstrated recently.38 Whereas the modification of typical strain patterns by hyperkalemia are well known, no definite criteria have been established for the electrocardiographic diagnosis of the not infrequent occurrence of hypokalemic changes in the presence of left heart strain ( fig. 3).…”

Section: Methodsmentioning

confidence: 92%

A Clinical Correlative Study of the Electrocardiogram in Electrolyte Imbalance

Dreifus¹,

Pick²

1956

Circulation

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There is no general agreement concerning the action of specific electrolyte disorders and acid-base balance upon concentrations by determining their intracellular/extracellular relationships. Crismon and associates8 could not relate the intracellular potassium concentration to typical electrocardiographic events in hyperkalemia. Bellet, too, could not establish a definite relationship of the electrocardiographic changes to skeletal muscle potassium content.9 He considered, among other possibilities, that differences in the metabolic activity of heart and skeletal muscle were the cause of this lack of correlation. His comparison of intracellular to extracellular potassium concentrations with the electrocardiogram gave no better results than serum potassium concentration alone. Ktihns,10 on the other hand, noted such a relationship in animal experiments. In relating intracellular/extracellular potassium concentrations he used a value termed "cardiac potassium quotient" with a normal range of 25 to 32. Reduction of this quotient was associated with typical hyperkalemic changes, and elevation with typical hypokalemic changes in the electrocardiogram. There was, however, no consistency between the electrocardiographic alterations and absolute potassium or sodium concentrations, intracellular or extracellular. Changes in the autonomic nerve tone and pharmacologic actions of epinephrine, insulin, veratrine, and in particular quinidine, have been noted to simulate electrocardiographic patterns of hypokalemia.9 [11][12][13] It is also well known that pre-existent or concomitant alterations of the ST-T segment caused by heart Circulation, Volume XIV, November 1956 by guest on May 9, 2018 http://circ.ahajournals.org/ Downloaded from

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Section: Methodsmentioning

confidence: 92%

A Clinical Correlative Study of the Electrocardiogram in Electrolyte Imbalance

Dreifus¹,

Pick²

1956

Circulation

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“…A low voltage of P and T waves is encountered when the con centration of serum potassium is low [2,6,7]. This could be the explanation for the results obtained after the injection of 20% NaCl, 40% urea and 50% glucose if we had not found the same changes after the injection of concentrated Ringer solution which contained 107 mEq K per liter.…”

Section: Discussionmentioning

confidence: 91%

Electrocardiographic Changes Following the Administration of Hypertonic Solutions to Dog

Salimi¹,

Khoyi²,

R³

et al. 1968

Pharmacology

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“…May, 1972 similar correlation in patients with various diseases.16) However, Ljunggren et al could not find such a consistent relationship in patients with rheumatoid arthritis treated with ACTH, cortisone and DOCA.22) Schwartz et al concluded that neither the total K deficit nor the serum K concentration was consistently related to the ECG changes.23) Herndon et al also could not find a significant correlation between Q-Tc and serum K concentration. 24) In another line of evidences, Jung and Jantz observed that U wave became prominent in hypopotassemia found in the patients with paroxysmal paralysis,25) and Ernstene and Proudfit first claimed that the apparent QT prolongation in hypopotassemia might be the result of a T-U fusion.26) After their publication, McAllen reported the same opinion,27) and Bellet also agreed the existence of such a fusion.28) On the other hand, Surawicz and his colleagues made much efforts to discriminate T and U waves, and stated implicitly and explicitly that the QT duration might in fact shortened in hypopotassemia.12),29)-35) Considering all these discussions, Weaver and Burchell concluded that QT duration increased slightly in hypopotassemia.4) In hyperpotassemia due to K loading, Dietrich and Wolff could not observe a significant correlation between QT duration and serum K concentration.36) However, in recent experiment of similar nature on human controls and patients, Schwarzbach concluded that QT duration was shortened by elevation of serum K.37) Our present computation confirmed the finding of Nadler et al that K had small negative effects on QT duration, although it did not reach the statistically significant level.…”

Section: Discussionmentioning

confidence: 99%

QT Duration and Plasma Electrolytes (Ca, Na, and K) in Uremic Patients

et al. 1972

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SUMMARYOn 79 ECG tracings obtained from 31 uremic patients, the influence of serum Ca, Na, and K concentrations on the QT duration in ECG was analyzed by multiple regression technique. It was found that Ca and K had negative and Na had a positive effect on QT duration, although only the effect of Ca was reaching the statistically significant level. Since serum electrolytes had correlations with each other, they were orthogonalized and tested for significance once again. Still Na and K did not reveal significant influences by this procedure. However, the effects of Na and K on QT duration were as the same direction and magnitude as reported in older literatures.In the course of orthogonalization it was found that Ca and Na had negative influences on K. It seems that this fact presents a sound basis for the therapeutic use of Ca and Na salts in hyperpotassemia. Additional Indexing Words: QT ratioCa therapy in hyperpotassemia Na therapy in hyperpotassemia Multiple regression analysis Orthogonalization T duration has as its components, the propagation of depolarization wave, membrane action potential duration, and propagation of repolarization wave.Each of these components is influenced by the heart rate and also by the electrolyte concentrations in the surrounding medium. So, it is natural that, beside the influence of the heart rate on QT duration in ECG,1) the effect of alterations in plasma Ca concentration on it has been one of the earliest findings in clinical electrocardiography.2) In 1948 Nadler et al. reported that QT duration was inversely correlated with the serum K concentration in patients with diabetic acidosis.3) This observation was not confirmed by several authors, and some also noticed that QT duration in cases of hypopotassemia

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The electrocardiographic effects of alterations in concentration of plasma chemicals

Cited by 21 publications

References 22 publications

A Clinical Correlative Study of the Electrocardiogram in Electrolyte Imbalance

A Clinical Correlative Study of the Electrocardiogram in Electrolyte Imbalance

Electrocardiographic Changes Following the Administration of Hypertonic Solutions to Dog

QT Duration and Plasma Electrolytes (Ca, Na, and K) in Uremic Patients

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