The document discusses various electrolyte abnormalities and their ECG manifestations, including hypercalcemia, hypocalcemia, hyperkalemia, hypokalemia, hypomagnesia, hyperthyroidism, hypothyroidism, and hypothermia. For each condition, it provides the normal and abnormal ranges for the electrolyte levels and describes the associated ECG changes such as peaked T waves, QT prolongation, low QRS voltage, bradycardia, and arrhythmias. The document serves as a reference for clinicians to recognize ECG patterns caused by electrolyte and endocrine abnormalities.

1. Domina Petric, MD
ECG H

2. Hypercalcaemia
Burns E. Hypercalcaemia (April 16, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/basics/hypercalcaemia/
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3. Calcium
Calcium Level (mmol/L)
Normal 2,1-2,6
Mild hypercalcaemia 2,7-2,9
Moderate hypercalcaemia 3,0-3,4
Severe hypercalcaemia >3,4

4. Causes of hypercalcaemia
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5. ECG features
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6. Example (Otero & Lenihan)
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Osborn (J) waves

7. Hypocalcaemia
Burns E. Hypocalcaemia (April 16, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/basics/ecg-features-of-hypocalcaemia/
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8. Hypocalcaemia
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Calcium Level (mmol/L)
Normal 2,1-2,6
Mild-moderate
hypocalcaemia
1,9-2,1
Severe hypocalcaemia <1,9

9. Causes
Hypoparathyroidism Vitamin D deficiency Acute pancreatitis Hyperphosphataemia
Hypomagnesaemia Diuretics (fursemide) Pseudohypoparathyroidism
Congenital disorders
(DiGeorge syndrome)
Critical illness (sepsis)
Factitious (EDTA blood tube
contamination)
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10. Symptoms
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11. ECG
QTc prolongation primarily by
prolongation of the ST
segment with T wave typically
unchanged.
Atrial fibrillation
and Torsades de
pointes may
occur.
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12. Hyperkalaemia
Burns E. Hyperkalaemia (April 16, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/basics/hyperkalaemia/
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13. Hyperkalaemia
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Potassium Level (mmol/L)
Hyperkalaemia >5,5
Moderate
hyperkalaemia
>6,0
Severe hyperkalaemia >7,0

14. Potassium >5,5 mmol/L
Repolarization abnormalities:
• peaked T waves (the earliest sign)
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15. Potassium >6,5 mmol/L
Progressive paralysis of the atria:
• P wave widens and flattens
• PR segment lengthens
• P waves eventually disappear
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Prolongation of PR segment
No P waves

16. Potassium >7,0 mmol/L
Conduction abnormalities and bradycardia:
• prolonged QRS interval with bizarre QRS
morphology
• high-grade AV block with slow junctional and
ventricular escape rhythms
• bundle branch blocks, fascicular blocks
• sinus bradycardia or atrial fibrillation with slow
ventricular response
• sine wave appearance (pre-terminal rhythm)
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Sine wave

17. Potassium >9,0 mmol/L
Cardiac arrest due to:
•PEA with bizarre, wide complex rhythm
•Asystole
•Ventricular fibrillation
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18. Hypokalaemia
Burns E. Hypokalaemia (April 16, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/basics/hypokalaemia/
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19. Hypokalaemia
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Potassium Level (mmol/L)
Hypokalaemia <3,5
Moderate
hypokalaemia
<3,0
Severe hypokalaemia <2,5

20. Potassium <2,7 mmol/L
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Prominent U wave
and T wave inversion

21. Severe hypokalaemia
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22. Note!
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23. Hypomagnesaemia
Burns E. Hypomagnesaemia (April 16, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/basics/hypomagnesaemia/
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24. Hypomagnesaemia
• Normal serum magnesium level is 0.8 – 1.0 mmol/L.
•Hypomagnesaemia is <0.8 mmol/L!
ECG features:
• prolonged QTc
• atrial and ventricular ectopy, atrial
tachyarrhythmias and torsades de pointes may occur
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25. Thyroid function abnormalities
Lifeinthefastlane.com
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26. Hyperthyroidism
• Sinus tachycardia!
• Atrial fibrillation with rapid ventricular response!
• High left-ventricular voltage!
Less frequent:
• supraventricular arrhythmias: premature atrial
beats, paroxysmal supraventricular tachycardia,
multifocal atrial tachycardia, atrial flutter
• non-specific ST and T wave changes
• ventricular extrasystoles
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27. Note!
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28. Hypothyroidism
Severe hypothyroidism (myxoedema) causes a triad of:
• Bradycardia!
• Low QRS voltage!
• Widespread T-wave inversions usually without ST
deviation!
Other ECG changes are:
• QT prolongation
• first degree AV block
• interventricular conduction delay
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29. Myxoedema triad
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Bradycardia of about 30/min!
Low QRS voltage!
T wave inversion without
ST-segment deviation in precordial leads!

30. Hypothermia
Burns E. Hypothermia (April 4, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/basics/hypothermia/
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31. Hypothermia
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32. Literature
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