Atrioventricular and intraventricular conduction in hyperkalemia

Bashour, Tali T.; Hsu, Irene; Gorfinkel, H. Joel; Wickramesekaran, Rajasekaran; Rios, Jorge C.

doi:10.1016/0002-9149(75)90001-6

Cited by 55 publications

(31 citation statements)

References 12 publications

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“…The changes on the ECG correlate roughly with the severity of hyperkalemia [1]. It has been, however, less recognized that severe hyperkalemia is associated with bradycardia [2]. We herein present 7 patients with end-stage renal disease manifesting marked bradycardia in the presence of hyperkalemia.…”

Section: Introductionmentioning

confidence: 98%

“…Although the depressed sinus rate in severe hyperkalemia has been demonstrated in experimental animals [3], marked bradycardia associated with hyperkalemia have scarcely been reported in humans [2]. Clinical report on 20 cases with electrocardiographic evidence of fascicular block during hyperkalemia included 6 cases of tachycardia and 1 case of bradycardia with a heart rate of 46/min [2, 4].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical report on 20 cases with electrocardiographic evidence of fascicular block during hyperkalemia included 6 cases of tachycardia and 1 case of bradycardia with a heart rate of 46/min [2, 4]. Although the reason why bradycardia occurs in some cases with profound hyperkalemia but not in others is not well defined, it is possible that the differences in the sensitivity of the pacemaker to hyperkalemia or the rate of rise in serum potassium concentration might be a factor.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Marked Bradycardia Associated with Profound Hyperkalemia in Patients with End-Stage Renal Disease

Abe¹,

Yonemura²,

Takahashi³

et al. 1998

Nephron

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Marked Bradycardia Associated with Profound Hyperkalemia in Patients with End-Stage Renal Disease

Abe¹,

Yonemura²,

Takahashi³

et al. 1998

Nephron

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“…Potassium is an important element in electrical conduction, and the association of high K + concentrations with arrhythmias, ventricular tachycardia and fibrillation has been well known for a long time (Pick, 1966;Bashour et al, 1975;Wishnitzer and Caspi, 1981;Ng et al, 1994;Mehta et al, 2001). Very high concentrations of serum K + have long been associated with the risk of cardiovascular morbidity and mortality (Fang et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Experimental hyperkalaemia in rabbits: Effects of salbutamol and norepinephrine treatments on blood biochemistry and electrocardiography

Çeli̇k

Bal

Durgut

2003

Acta Veterinaria Hungarica

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The effects of salbutamol and norepinephrine on the electrocardiogram (ECG), serum potassium level and enzyme activities were studied in rabbits with hyperkalaemia; norepinephrine and salbutamol may be therapeutically useful. For induction of hyperkalaemia, 300 mM KCl solution was used and then isotonic saline solution containing 6 µg salbutamol and 3.9 µg norepinephrine per ml were administered. Norepinephrine and salbutamol decreased the serum potassium from 7.36 ± 0.26 and 7.21 ± 0.31 mmol/L to 5.62 ± 0.27 and 4.35 ± 0.33 mmol/L, respectively, and caused the ECG changes (flatness of P wave, widening of QRS complex and bradycardia) to return to the control conditions (time 0). Norepinephrine, but not salbutamol, decreased the activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) to the control levels. These results suggest that monitoring of the enzyme activities might be useful as it yields indexes suitable for evaluating the therapeutic approach with norepinephrine in hyperkalaemia.

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“…The PR interval can be enlarged together with an advanced AV block, and the QRS complex can be widened along with a multitude of alterations in intraventricular conduction (left branch block, right branch block, bifascicular block, etc). 39 If hyperkalemia intensifies, this can lead to ventricular tachycardia, ventricular fibrillation, and asystole, typically preceded by sinusoidal rhythm. This rhythm corresponds to monophasic waves formed by the fusion of the wide QRS complex with the T wave, which simulate a ventricular flutter.…”

mentioning

confidence: 99%

Hyperkalemia in heart failure patients: current challenges and future prospects

López‐Vilella¹,

Morillas-Climent²,

Plaza-López³

et al. 2016

RRCC

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Abstract:In heart failure (HF), hyperkalemia is a frequent problem because of several factors, such as neurohormonal mechanisms involved in the disease, renal failure, comorbidities, and drugs with a prognostic benefit. These drugs can block the renin-angiotensin-aldosterone system, and therefore, serum potassium levels can increase, mostly when combined with other drugs as nonsteroidal anti-inflammatories, digitalis, heparin, etc. Hyperkalemia can have severe consequences if not corrected, mostly at the cardiac level (decrease in speed conduction, QRS enlargement, ventricular arrhythmias, and asystole). Therefore, it is important to adequately prescribe these potentially harmful drugs (starting at low doses with close monitoring of renal function and potassium levels), to carefully manage the factors that can interfere with potassium levels, and to early treat hyperkalemia if it develops. There are several investigation lines for the design of new molecules that show a similar efficacy to that of renin-angiotensin-aldosterone system, with a lower risk of hyperkalemia: nonsteroidal mineralocorticoid receptor antagonists like finerenone, which is a more cardioselective drug than traditional mineralocorticoid receptor antagonists, and angiotensin and neprilysin inhibitors such as LCZ696, which have proven to reduce mortality and heart failure hospitalizations. Besides, new drugs are being studied, which are able to reduce levels of serum potassium in a sustained and faster way, like chelating polymers Patiromer and sodium zirconium cyclosilicate.

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Atrioventricular and intraventricular conduction in hyperkalemia

Cited by 55 publications

References 12 publications

Marked Bradycardia Associated with Profound Hyperkalemia in Patients with End-Stage Renal Disease

Marked Bradycardia Associated with Profound Hyperkalemia in Patients with End-Stage Renal Disease

Experimental hyperkalaemia in rabbits: Effects of salbutamol and norepinephrine treatments on blood biochemistry and electrocardiography

Hyperkalemia in heart failure patients: current challenges and future prospects

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