Hyperkalaemia and bradycardia
Author Ольга Кияница
Hypercalemia m bradycardia is often interconnected states, one of which provokes the development of the latter. This is explained by the fact that potassium is directly involved in the metabolic processes of the entire body and the heart muscle in particular. Therefore, with its excess, a violation of the rhythm with the manifestation of the corresponding clinic develops.
Potassium is a cation, 90% concentrated in the intracellular fluid. The remaining 10% comes from serum and extracellular fluid. Depending on the intra- and extracellular concentration of potassium, one can speak of normal or disturbed electrical activity of the excitable structures.
With potassium metabolism disorder, two major pathologies develop - hypokalemia and hyperkalemia. Hyperkalaemia plays an important role in the pathogenesis of bradycardia. Laboratory tests are often used to diagnose it. It is also important to know other symptoms, causes and methods of treating a pathological condition.
Video Hyperkalemia. Symptoms, signs and methods of treatment
Description of hypercalemia and bradycardia
Potassium is an important trace element essential for normal heart function. But both its deficiency and excesses lead to various forms of rhythm disturbance.
A person should consume so many foods rich in potassium that within a day this microelement enters the body of 2-4 g. Approximately the same amount is excreted by the kidneys from the body.
In serum, potassium should contain about 3.5-5 mmol / l. Everything above 6 mmol / L indicates hyperkalemia. In this condition there is a lot of disorders in the body, but the most unpleasant are connected with the heart muscle. In excess of potassium in the blood, the myocardium reacts as follows:
- disorder of automatism;
- conduction disturbance;
- change in cardiomyocyte excitability.
As a result of such processes, the activation of pulses is slowed down, the heart rate decreases. In addition, the stage of repolarization changes, which becomes shorter and unproductive.
Bradycardia with hyperkalemia is only the first stage of the pathological process. With an increase in the cation concentration up to 8-10 mmol / l, the atrioventricular blockade may develop. In some cases, intraventricular blockage of stimulation pulses is observed. At level 13 mmol / l and above, the excitability of the heart muscle sharply decreases, which threatens heart failure in the diastole phase.
Symptoms of hyperkalaemia and bradycardia
One of the signs of a pathological condition is a violation of the heart rhythm. In a mild degree of hyperkalemia, it is a bradycardia, that is, a slowed heart rhythm with less than 60 beats per minute. The patient may experience weakness, lethargy, apathy, sometimes there is a feeling of lack of air or a heart stop. Other equally important symptoms of the pathology are intestinal atony, muscle weakness, pain in the arms and legs, muscle paralysis.
In a number of cases hyperkalaemia, as well as hypokalemia, can occur without a pronounced clinic.
Characteristic signs of hypercalemia:
- slow heartbeat;
- shortness of breath;
- painful sensations in the chest;
- nausea and vomiting.
The large or less pronounced symptoms do not always accurately indicate the concentration of potassium in the blood.This indicator is precisely determined by laboratory tests.
Causes of hyperkalaemia and bradycardia
Slow rhythm arises in the background of hyperkalemia, therefore the causes of the development of this pathology are studied in the process of examination of the patient.
Major groups of causes of hyperkalaemia:
- Violation of the process of excretion - in this process, kidneys are often involved, since most of the trace element is extracted precisely with their help. When renal failure, when the structure of the organ changes and the renal tubules begin to pass less potassium than normal, even the lack of trace mineral nutrition can cause hyperkalemia. In hypodarteronism, which occurs in the background of adrenal insufficiency, nephropathy, systemic lupus erythematosus, amyloidosis, the level of potassium in serum can also increase.
- The transfer of potassium from cells to the blood-like is observed in various pathologies. For example, with massive destruction of blood and tissue cells, extensive ischemia or hypoxia, with trauma and severe burns. Also, redistribution of the cation is facilitated by hypopheninemia, intracellular acidosis,
There is another reason - the introduction of large amounts of potassium with medicines or food. But such hyperkalemia is not stable, therefore, it does not lead to significant cardiac disorders. Although in a number of cases, the pathology can develop on the background of taking large doses of potassium salts or after transfusion of significant volumes of blood in a state of hemolysis.
Diagnosis of hyperkaliemia and bradycardia
During the study of the patient's condition, various methods of research are used. The most effective of these are the following:
- Electrocardiography - signs of bradycardia are defined: reduction of heart rate, elongation of the interval of RR, increase of the ventricular complex, sharpening of the T wave.
- General blood test.
- The analysis of potassium in serum, by which the degree of hyperkalaemia is determined.
- Review of medicines used by the patient.
- Evaluation of kidney function.
The proposed list of compulsory analyzes may be supplemented by determining the following parameters: glucose and digoxin levels in blood, aldosterone and cortisol in serum, blood composition of blood, urinary myoglobin. Urine analysis may also be performed, especially in those cases where blood was found in the urine.
Treatment and prevention of hypercalemia with bradycardia
First of all, the cause of the development of hyperkalaemia should be identified and eliminated. Further increase activity of transfer of potassium from intercellular fluid into cells. To do this, use:
- Calcium chloride - intravenously in the form of a solution.
- Glucose with insulin - are administered at the same time intravenously.
- Sodium bicarbonate - used as a solution for intravenous administration.
The following drugs are used to stimulate potassium excretion:
- Diuretics (furosemide).
- Aldosteron containing agents (trimethylacetate).
- Cation exchange resins (polystyrene sodium sulfate).
- Hemodialysis, or blood purification.
Dietary nutrition for hyperkalaemia with bradycardia:
- The diet should consist of products with low potassium content (bread, pasta, white rice, strawberries, grapes, apples, cabbage, cucumbers, eggplants, eggs, chicken and turkey.
- You can not use the following products: bananas, watermelons, peaches, nuts, red meat.
- Avoid fast foods and offal, as well as products with trans fatty acids (confectionery in the form of cakes, pastries, products on margarine).
- It is useful to use fish of low-grade varieties, preferably sea.
- From vegetable oils should be preferred to olive, linen, coconut.
- On the day you need to drink enough pure water, not less than 1.5 liters.
In addition, you must abandon such harmful habits as smoking and drinking alcohol, strong tea and coffee.
Prevention of hyperkalaemia, and therefore bradycardia, reduces itself to preventing the development of the above-mentioned causes. You should also have enough physical activity to increase the metabolism of potassium in the body.