![]() At this point, the P wave diminishes further in amplitude, and with continued elevation of the serum potassium level, ultimately disappears (see Figures 1 and 2). Eventually, the QRS complex blends with the T wave, forming a "sine-wave," or sinusoidal structure on the ECG (see Figures 1, 2, and 4C). At progressively higher serum levels, the QRS complex widens (see Figure 4B), at times resembling QRS complexes seen in bundle-branch blocks. Thus, PR-interval prolongation occurs first, followed by a dampening of the P wave. All cardiac myocytes are sensitive to elevated potassium levels atrial tissue, however, is significantly more sensitive than other cardiac tissues to the effects of hyperkalemia. The polarity of the T wave may also change, particularly in patients with left ventricular hypertrophy, in whom the normally inverted lateral T waves become upright or "pseudonormalized." 3 A further increase in the serum potassium level slows or prolongs cardiac conduction. 1 The prominent T wave is considered the first ECG manifestation of hyperkalemia.1 This prominent T wave is described as tall and narrow with a symmetric structure (see Figures 3 and 4A). ![]() ![]() Modest increases in the serum potassium level enhance or accentuate repolarization of the myocyte, which is manifested electrocardiographically by alterations in the appearance of the T wave (Figures 1, 2, 3, and 4).
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