Electrolyte abnormalities and

ECG
Elias Hanna, MD
LSU Cardiology
 Hyperkalemia:

T wave in hyperkalemia is
typically tall and narrow,
but does not have to be tall
(may be just narrow and
peaked pulling ST segment).

Tall T means > 2 big boxes in

the precordial leads or >1
small box in limb leads,
or T wave taller than QRS.
 Hypokalemia:

ST depression with prominent T

Flat T with K~3
(actually U) and prolonged QT
when K<2.5-3
 Hypokalemia:
-T progressively flattens
-U wave more and more prominent (looks like
T)
-ST-segment more and more depressed

Large U wave simulates and hides T wave with severe hypokalemia, the ST-T pattern
may mimick:
ST-segment depression with a flat or upright wide T wave (actually U)
and a prolonged QT interval (actually QTU)
On the other hand, the pattern of T inversion is not seen with hypokalemia:
 ECG changes of digoxin effect (digoxin
therapy) simulate the changes seen with
hypokalemia (U wave and ST depression),
except that with digoxin therapy QT is not
prolonged
Hypocalcemia:
Long QT that is due to a long ST segment, which is different from long
QT due to congenital long QT syndrome, drugs, or hypokalemia. T wave
is not wide, there is no T wave abnormality.
Hypercalcemia: short QTc <390 ms. No significant ST or T wave abnormality
 Hypomagnesemia is not associated with
characteristic or specific ECG findings
It is associated with a non-specific
prolongation of QT and/or QRS intervals, and
is often associated with hypokalemia and
hypocalcemia. Therefore, changes related to
the latter 2 abnormalities may be seen.