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The Arrhythmic Patient in the Emergency Department pp 129–150Cite as

Acute Management of Patients with Arrhythmias and Non-cardiac Diseases: Metabolite Disorders and Ion Disturbances

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Abstract

Acute metabolic disorders are relatively common amongst medical and surgical patients, especially in the critically ill. Whilst increasing the complexity of management plans, these circumstances also increase the risk of cardiac complications, such as arrhythmias, and furthermore are associated with increased mortality. Arrhythmic risk is promoted by electrolyte, acid-base and fluid balance disturbance, increased sympathetic drive and cardiac ischaemia. Particularly, electrolyte abnormalities may generate or facilitate clinical arrhythmias, even in the setting of normal cardiac tissue, by modulating ion conduction across (specific) cardiac cell membrane channels [1], and management of the underlying pathology may be all that is required to allow rapid normalisation of the metabolic profile. Moreover, complex pharmacological regimes may exacerbate the situation [2].

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Bibliography

  1. El-Sherif N, Turitto G. Electrolyte disorders and arrhythmogenesis. Cardiol J. 2011;18:233–45.

    PubMed  Google Scholar 

  2. Kraft MD, Btaiche IF, Sacks GS, et al. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm. 2005;62:1663–82.

    Article  CAS  PubMed  Google Scholar 

  3. Task FM, Zipes DP, Camm AJ, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death – executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J. 2006;27:2099–140.

    Article  Google Scholar 

  4. Whalley DW, Wendt DJ, Grant AO. Electrophysiologic effects of acute ischemia and reperfusion and their role in the genesis of cardiac arrhythmias. In: Podrid PJ, Kowey PR, editors. Cardiac arrhythmia: mechanisms, diagnosis, and management. Baltimore: Williams & Wilkins; 1995. p. 109–30.

    Google Scholar 

  5. Ramaswamy K, Hamdan MH. Ischemia, metabolic disturbances, and arrhythmogenesis: mechanisms and management. Crit Care Med. 2000;28(Suppl):N151–7.

    Article  CAS  PubMed  Google Scholar 

  6. Nesher G, Zion MM. Recurrent ventricular tachycardia in hypothyroidism report of a case and review of the literature. Cardiology. 1988;75:301–6.

    Article  CAS  PubMed  Google Scholar 

  7. Osborn LA, Skipper B, Arellano I, et al. Results of resting and ambulatory electrocardiograms in patients with hypothyroidism and after return to euthyroid status. Heart Dis. 1999;1:8–11.

    CAS  PubMed  Google Scholar 

  8. Singh AK, Nguyen PN. Refractory ventricular tachycardia following aortic valve replacement complicated by unsuspected pheochromocytoma. Thorac Cardiovasc Surg. 1993;41:372–3.

    Article  CAS  PubMed  Google Scholar 

  9. Michaels RD, Hays JH, O’Brian JT, et al. Pheochromocytoma associated ventricular tachycardia blocked with atenolol. J Endocrinol Invest. 1990;13:943–7.

    Article  CAS  PubMed  Google Scholar 

  10. Shimizu K, Miura Y, Meguro Y, et al. QT prolongation with torsades de pointes in pheochromocytoma. Am Heart J. 1992;124:235–9.

    Article  CAS  PubMed  Google Scholar 

  11. Viskin S, Fish R, Roth A, et al. Clinical problem-solving. QT or not QT? N Engl J Med. 2000;343:352–6.

    Article  CAS  PubMed  Google Scholar 

  12. Colao A. Are patients with acromegaly at high risk for dysrhythmias? Clin Endocrinol (Oxf). 2001;55:305–6.

    Article  CAS  Google Scholar 

  13. Kahaly G, Olshausen KV, Mohr-Kahaly S, et al. Arrhythmia profile in acromegaly. Eur Heart J. 1992;13:51–6.

    Article  CAS  PubMed  Google Scholar 

  14. Colao A, Ferone D, Marzullo P, et al. Long-term effects of depot long-acting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly. J Clin Endocrinol Metab. 2001;86:2779–86.

    CAS  PubMed  Google Scholar 

  15. Minniti G, Moroni C, Jaffrain-Rea ML, et al. Marked improvement in cardiovascular function after successful transsphenoidal surgery in acromegalic patients. Clin Endocrinol (Oxf). 2001;55:307–13.

    Article  CAS  Google Scholar 

  16. Suyama K, Uchida D, Tanaka T, et al. Octreotide improved ventricular arrhythmia in an acromegalic patient. Endocr J. 2000;47(Suppl):S73–5.

    Article  PubMed  Google Scholar 

  17. Lombardi G, Colao A, Marzullo P, et al. Improvement of left ventricular hypertrophy and arrhythmias after lanreotide-induced GH and IGF-I decrease in acromegaly. A prospective multi-center study. J Endocrinol Invest. 2002;25:971–6.

    Article  CAS  PubMed  Google Scholar 

  18. Colao A, Marzullo P, Cuocolo A, et al. Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide. Clin Endocrinol (Oxf). 2003;58:169–76.

    Article  CAS  Google Scholar 

  19. Izumi C, Inoko M, Kitaguchi S, et al. Polymorphic ventricular tachycardia in a patient with adrenal insufficiency and hypothyroidism. Jpn Circ J. 1998;62:543–5.

    Article  CAS  PubMed  Google Scholar 

  20. Abdo A, Bebb RA, Wilkins GE. Ventricular fibrillation: an extreme presentation of primary hyperaldosteronism. Can J Cardiol. 1999;15:347–8; 549.

    CAS  PubMed  Google Scholar 

  21. Chang CJ, Chen SA, Tai CT, et al. Ventricular tachycardia in a patient with primary hyperparathyroidism. Pacing Clin Electrophysiol. 2000;23:534–7.

    Article  CAS  PubMed  Google Scholar 

  22. Wallace TM, Matthews DR. Recent advances in the monitoring and management of diabetic ketoacidosis. QJM. 2004;97:773–80.

    Article  CAS  PubMed  Google Scholar 

  23. Harrower C. The value of continuous ECG monitoring during treatment of diabetic ketoacidosis. A computer study. Acta Diabetol Lat. 1975;15:88–94.

    Article  Google Scholar 

  24. American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: life-threatening electrolyte abnormalities. Circulation. 2005;112:IV-121–5.

    Article  Google Scholar 

  25. Diercks DB, Shumaik GM, Harrigan RA, Brady WJ, Chan TC. Electrocardiographic manifestations: electrolyte abnormalities. J Emerg Med. 2004;27:153–60.

    Article  PubMed  Google Scholar 

  26. Brobst D. Review of the pathophysiology of alterations in potassium homeostasis. J Am Vet Med Assoc. 1986;188:1019–25.

    CAS  PubMed  Google Scholar 

  27. Brown RS. Potassium homeostasis and clinical implications. Am J Med. 1984;77:3–10.

    Article  CAS  PubMed  Google Scholar 

  28. Yu AS. Atypical electrocardiographic changes in severe hyperkalemia. Am J Cardiol. 1990;77:906–8.

    Article  Google Scholar 

  29. Martinez-Vea A, Bardaji A, Garcia C, Oliver JA. Severe hyperkalemia with minimal electrocardiographic manifestations: a report of seven cases. J Electrocardiol. 1999;32:45–9.

    Article  CAS  PubMed  Google Scholar 

  30. Moore ML, Bailey RR. Hyperkalaemia in patients in hospital. N Z Med J. 1989;102:557–8.

    CAS  PubMed  Google Scholar 

  31. Stevens MS, Dunlay RW. Hyperkalemia in hospitalized patients. Int Urol Nephrol. 2000;32:177–80.

    Article  CAS  PubMed  Google Scholar 

  32. Paice B, Gray JM, McBride D, et al. Hyperkalaemia in patients in hospital. Br Med J (Clin Res Ed). 1983;286:1189–92.

    Article  CAS  Google Scholar 

  33. Shemer J, Modan M, Ezra D, et al. Incidence of hyperkalemia in hospitalized patients. Isr J Med Sci. 1983;19:659–61.

    CAS  PubMed  Google Scholar 

  34. Surawicz B. Relationship between electrocardiogram and electrolytes. Am Heart J. 1967;73:814–34.

    Article  CAS  PubMed  Google Scholar 

  35. Freeman K, Feldman JA, Mitchell P, et al. Effects of presentation and electrocardiogram on time to treatment of hyperkalemia. Acad Emerg Med. 2008;15:239–49.

    Article  PubMed  Google Scholar 

  36. Fisch C. Relation of electrolyte disturbances to cardiac arrhythmias. Circulation. 1973;47:408–19.

    Article  CAS  PubMed  Google Scholar 

  37. Jackson MA, Lodwick R, Hutchinson SG. Hyperkalaemic cardiac arrest successfully treated with peritoneal dialysis. BMJ. 1996;312:1289–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Voelckel W, Kroesen G. Unexpected return of cardiac action after termination of cardiopulmonary resuscitation. Resuscitation. 1996;32:27–9.

    Article  CAS  PubMed  Google Scholar 

  39. Niemann JT, Cairns CB. Hyperkalemia and ionized hypocalcemia during cardiac arrest and resuscitation: possible culprits for postcountershock arrhythmias? Ann Emerg Med. 1999;34:1–7.

    Article  CAS  PubMed  Google Scholar 

  40. Slovis C, Jenkins R. Conditions not primarily affecting the heart. BMJ. 2002;324:1320–3.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mattu A, Brady WJ, Robinson DA. Electrocardiographic manifestations of hyperkalemia. Am J Emerg Med. 2000;18:721–6.

    Article  CAS  PubMed  Google Scholar 

  42. Webster A, Brady W, Morris F. Recognising signs of danger: EKG changes resulting from an abnormal serum potassium concentration. Emerg Med J. 2002;19:74–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Ettinger PO, Regan TJ, Oldewurtel HA. Hyperkalemia, cardiac conduction and the electrocardiogram: a review. Am Heart J. 1974;88:360–71.

    Article  CAS  PubMed  Google Scholar 

  44. Levine HD, Wanzer SH, Merrill JP. Dialyzable currents of injury in potassium intoxication resembling acute myocardial infarction or pericarditis. Circulation. 1956;13:29–36.

    Article  CAS  PubMed  Google Scholar 

  45. Paice BJ, Paterson KR, Onyanga-Omara F, et al. Record linkage study of hypokalemia in hospitalized patients. Postgrad Med J. 1986;62:187–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Schulman M, Narins RG. Hypokalemia and cardiovascular disease. Am J Cardiol. 1990;65:4E–9.

    Article  CAS  PubMed  Google Scholar 

  47. Thompson RG, Gobb LA. Hypokalemia after resuscitation out-of-hospital ventricular fibrillation. JAMA. 1982;248:2860–3.

    Article  CAS  PubMed  Google Scholar 

  48. Surawicz B, Braun HA, Crum WB, et al. Quantitative analysis of the electrocardiographic pattern of hypopotassemia. Circulation. 1957;16:750–63.

    Article  CAS  PubMed  Google Scholar 

  49. Surawicz B. Electrolytes and the electrocardiogram. Postgrad Med. 1974;55:123–9.

    Article  CAS  PubMed  Google Scholar 

  50. Yan GX, Lankipalli RS, Burke JK, Musco S, Kowey PR. Ventricular repolarization components of the electrocardiogram: cellular basis and clinical significance. J Am Coll Cardiol. 2003;42:401.

    Article  PubMed  Google Scholar 

  51. Agus ZS, Wasserstein A, Goldfarb S. Disorders of calcium and magnesium homeostasis. Am J Med. 1982;72:473–9.

    Article  CAS  PubMed  Google Scholar 

  52. Dyckner T, Wester PO. Relation between potassium, magnesium and cardiac arrhythmias. Acta Med Scand Suppl. 1981;647:163–9.

    CAS  PubMed  Google Scholar 

  53. Navarro-Gonzalez JF. Magnesium in dialysis patients: serum levels and clinical implications. Clin Nephrol. 1998;49:373–8.

    CAS  PubMed  Google Scholar 

  54. Fiset C, Kargacin ME, Kondo CS, Lester WM, Duff HJ. Hypomagnesemia: characterization of a model of sudden cardiac death. J Am Coll Cardiol. 1996;27:1771–6.

    Article  CAS  PubMed  Google Scholar 

  55. Leier CV, Dei Cas L, Metra M. Clinical relevance and management of the major electrolyte abnormalities in congestive heart failure: hyponatremia, hypokalemia, and hypomagnesemia. Am Heart J. 1994;128:564–74.

    Article  CAS  PubMed  Google Scholar 

  56. Bushinsky DA, Monk RD. Electrolyte quintet: calcium. Lancet. 1998;352:306–11.

    Article  CAS  PubMed  Google Scholar 

  57. Barri YM, Knochel JP. Hypercalcemia and electrolyte disturbances in malignancy. Hematol Oncol Clin North Am. 1996;10:775–90.

    Article  CAS  PubMed  Google Scholar 

  58. Aldinger KA, Samaan NA. Hypokalemia with hypercalcemia: prevalence and significance in treatment. Ann Intern Med. 1977;87:571–3.

    Article  CAS  PubMed  Google Scholar 

  59. Ziegler R. Hypercalcemic crisis. J Am Soc Nephrol. 2001;12 Suppl 17:S3–9.

    PubMed  Google Scholar 

  60. Carlstedt F, Lind L. Hypocalcemic syndromes. Crit Care Clin. 2001;17:139–53.

    Article  CAS  PubMed  Google Scholar 

  61. Campistol JM, Almirall J, Montoliu J, Revert L. Electrographic alterations induced by hyperkalaemia simulating acute myocardial infarction. Nephrol Dial Transplant. 1989;4:233–5.

    Article  CAS  PubMed  Google Scholar 

  62. Forsythe SM, Schmidt GA. Sodium bicarbonate for the treatment of lactic acidosis. Chest. 2000;117:260–7.

    Article  CAS  PubMed  Google Scholar 

  63. Viallon AM, Zeni FM, Lafond PM, et al. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999;27:2690–3.

    Article  CAS  PubMed  Google Scholar 

  64. Committee M, Blomstrom-Lundqvist C, Scheinman MM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias) Developed in collaboration with NASPE-Heart Rhythm Society. Eur Heart J. 2003;24:1857–97.

    Article  Google Scholar 

  65. Friedman P, Stevenson W. Proarrhythmia. Am J Cardiol. 1998;82:50N–8.

    Article  CAS  PubMed  Google Scholar 

  66. Weisberg LS. Management of severe hyperkalemia. Crit Care Med. 2008;36:3246–51.

    Article  PubMed  Google Scholar 

  67. Ngugi NN, McLigeyo SO, Kayima JK. Treatment of hyperkalaemia by altering the transcellular gradient in patients with renal failure: effect of various therapeutic approaches. East Afr Med J. 1997;74:503–9.

    CAS  PubMed  Google Scholar 

  68. Allon M, Shanklin N. Effect of bicarbonate administration on plasma potassium in dialysis patients: interactions with insulin and albuterol. Am J Kidney Dis. 1996;28:508–14.

    Article  CAS  PubMed  Google Scholar 

  69. al-Ghamdi SM, Cameron EC, Sutton RA. Magnesium deficiency: pathophysiologic and clinical overview [see comments]. Am J Kidney Dis. 1994;24:737–52.

    Google Scholar 

  70. Edelson GW, Kleerekoper M. Hypercalcemic crisis. Med Clin North Am. 1995;79:79–92.

    Article  CAS  PubMed  Google Scholar 

  71. Orchard CH, Cingolani HE. Acidosis and arrhythmias in cardiac muscle. Cardiovasc Res. 1994;28:1312–9.

    Article  CAS  PubMed  Google Scholar 

  72. Littmann L, Monroe MH, Taylor 3rd L, Brearley Jr WD. The hyperkalemic Brugada sign. J Electrocardiol. 2007;40:53–9.

    Article  PubMed  Google Scholar 

  73. Barold SS, Leonelli F, Herweg B. Hyperkalemia during cardiac pacing. Pacing Clin Electrophysiol. 2007;30:1–3.

    PubMed  Google Scholar 

  74. Elliott MJ, Ronksley PE, Catherine M, Ahmed SB, Hemmelgarn BR. Management of patients with acute hyperkalemia. CMAJ. 2010;10:182–15.

    Google Scholar 

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Authors and Affiliations

  1. Cardiology Unit, Gorizia Hospital, AAS 2 Bassa Friulana - Isontina, Gorizia, Italy

    Stefano Bardari

  2. Institute for Maternal and Child Health-IRCCS, Burlo Garofalo, University of Trieste, Trieste, Italy

    Biancamaria D’Agata

  3. Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy

    Gianfranco Sinagra

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  1. Stefano Bardari
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  2. Biancamaria D’Agata
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  3. Gianfranco Sinagra
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Correspondence to Stefano Bardari .

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Editors and Affiliations

  1. Cardiovascular Department, Cattinara University Hospital, Trieste, Italy

    Massimo Zecchin

  2. Cardiovascular Department, Cattinara University Hospital Cardiovascular Department, Trieste, Italy

    Gianfranco Sinagra

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Bardari, S., D’Agata, B., Sinagra, G. (2016). Acute Management of Patients with Arrhythmias and Non-cardiac Diseases: Metabolite Disorders and Ion Disturbances. In: Zecchin, M., Sinagra, G. (eds) The Arrhythmic Patient in the Emergency Department. Springer, Cham. https://doi.org/10.1007/978-3-319-24328-3_9

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  • DOI: https://doi.org/10.1007/978-3-319-24328-3_9

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