The most important difference is in value of Q waves in the diagnosis. Our findings support the use of the ECG to risk stratify patients with severe hyperkalemia for short-term adverse events. Traditionally ECG changes in myocardial infarction in the setting of LBBB include ST segment abnormalities, abnormal Q waves and Cabrera’s sign.1 There are however some differences in the setting of LBBB and ventricular pacing. There was no statistically significant correlation between peaked T waves and short-term adverse events (RR 0.77, 95% CI ). While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. An increased likelihood of short-term adverse event was found for hyperkalemic patients whose ECG demonstrated QRS prolongation (relative risk 4.74, 95% CI ), bradycardia (HR<50) (RR 12.29, 95%CI ), and/or junctional rhythm (RR 7.46, 95%CI 5.28-11.13). Hyperkalemia is defined as a serum or plasma potassium level above the upper limits of normal, usually greater than 5.0 mEq/L to 5.5 mEq/L. All patients who had a short-term adverse event had a preceding ECG that demonstrated at least one hyperkalemic abnormality (100%, 95% confidence interval ). All adverse events occurred prior to treatment with calcium and all but one occurred prior to K +-lowering intervention. Adverse events occurred within six hours in 28 patients (15%): symptomatic bradycardia (n=22), death (n=4), ventricular tachycardia (n=2) and CPR (n=2). We included a total of 188 patients with severe hyperkalemia in the final study group. Relative risk was calculated to determine the association between specific hyperkalemic ECG abnormalities and short-term adverse events. Two emergency physicians blinded to study objective independently examined each ECG for rate, rhythm, peaked T wave, PR interval duration and QRS complex duration. We defined adverse events as symptomatic bradycardia, ventricular tachycardia, ventricular fibrillation, cardiopulmonary resuscitation (CPR) and/or death. A chart review identified patient demographics, concurrent laboratory values, ECG within one hour of K+ measurement, treatments and occurrence of adverse events within six hours of ECG. We collected records of all adult patients with potassium (K+) ≥6.5 mEq/L in the hospital laboratory database from August 15, 2010, through January 30, 2015. This study analyzes the association between specific hyperkalemic ECG abnormalities and the development of short-term adverse events in patients with severe hyperkalemia. However, there is a paucity of evidence to support this practice. The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are at risk for adverse events.
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