Does hyperkalemia cause a fast or slow heart rate?

Written by Wei Shi Liang
Intensive Care Unit
Updated on March 09, 2025
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Hyperkalemia often causes a slowed heart rate and is associated with various arrhythmias. When serum potassium is between 6.6 to 8.0 mmol/L, tented T-waves may be observed. When serum potassium levels rise rapidly, it can lead to ventricular tachycardia or even ventricular fibrillation. On the other hand, a slow increase in serum potassium can cause conduction blocks, and in severe cases, may lead to cardiac arrest. These are the heart rate changes caused by hyperkalemia, which typically result in a slower heart rate.

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Written by Wei Shi Liang
Intensive Care Unit
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What are the causes of hyperkalemia?

Hyperkalemia, with blood potassium levels greater than 5.5 mmol/L, commonly occurs due to decreased potassium excretion or abnormal potassium transport within cells, as well as other reasons such as excessive intake. Decreased potassium excretion can commonly be due to renal failure, the use of potassium-sparing diuretics, renal tubular acidosis, and reduced secretion of corticosteroid aldosterone. Abnormal potassium transport includes conditions such as acidosis, rhabdomyolysis, extensive burns, severe trauma, intestinal necrosis, and peritoneal bleeding, among other diseases. Excessive potassium intake can be due to sample hemolysis or an elevation in white blood cells, both of which can lead to hyperkalemia. Therefore, it is crucial to be vigilant in clinical settings and address the condition promptly and appropriately.

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Written by Wei Shi Liang
Intensive Care Unit
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Common symptoms of hypokalemia and hyperkalemia

The common symptoms of hyperkalemia and hypokalemia, mainly seen in severe cases of high or low potassium, manifest as neurological and muscular symptoms as well as circulatory system symptoms, which are fairly similar in both conditions. If the blood potassium is particularly low, less than 2.0 mmol per liter, it can lead to reduced or absent reflexes. In severe cases, this may progress to paralysis of the respiratory muscles, causing respiratory pump failure. For hyperkalemia, particularly severe cases may also present with swallowing difficulties and respiratory distress. These central nervous system issues can lead to confusion and fainting. Another similar issue is the impact on the circulatory system; severe hypokalemia can cause ventricular tachycardia and even ventricular fibrillation, leading to death. In hyperkalemia, the impact on the cardiovascular system primarily causes malignant tachycardia and can also result in ventricular fibrillation. The main cause of sudden death in hyperkalemia is ventricular fibrillation and cardiac arrest, demonstrating that severe hyperkalemia and hypokalemia similarly cause significant arrhythmic conditions in the heart.

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Written by Wei Shi Liang
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The impact of hyperkalemia on the heart

The effects of hyperkalemia on the heart mainly manifest in the following ways: First, it affects the excitability of the myocardium, as hyperkalemia can cause reduced or even absent myocardial excitability; second, it impacts myocardial conductivity. In hyperkalemia, due to the reduced resting potential, the amplitude and speed of the action potential's phase zero decrease, leading to slowed excitability spread and reduced conductivity; third, it influences the automaticity of the myocardium. In hyperkalemia, due to slowed automatic depolarization, the automaticity is reduced. Additionally, hyperkalemia produces characteristic changes in the electrocardiogram, such as depression or disappearance of the P wave, prolongation of the PR interval, widening of the S wave, and narrowing and peaking of the T wave, which are the main changes in the electrocardiogram due to hyperkalemia.

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What are the causes of hyperkalemia?

The first reason is the excessive intake or administration of potassium, which can lead to hyperkalemia. For example, consuming foods that are very rich in potassium, or intravenously infusing solutions containing potassium. Additionally, the use of potassium salts of penicillin can also cause hyperkalemia, as well as the transfusion of stored blood, which can easily lead to hyperkalemia. Besides excessive intake and administration of potassium, diseases related to reduced excretion can also cause hyperkalemia, such as the most common instances during acute or chronic renal failure, where patients are prone to hyperkalemia. Furthermore, patients with reduced adrenal cortex function, such as aldosterone deficiency or Addison's disease, are also prone to hyperkalemia. Additionally, the use of diuretics that inhibit potassium excretion, notably spironolactone—a potassium-sparing diuretic—can also cause an increase in blood potassium levels. Another reason is a change in potassium distribution, such as when potassium moves from inside the cells to the outside, which can easily lead to hyperkalemia. This is common in cases of tissue damage, such as muscle contusion, or electrical burns, and tissue hypoxia, which also can easily lead to a change in potassium distribution, causing an increase in extracellular potassium. If hemolysis occurs in a test tube, such as if the venipuncture takes too long, or in conditions like leukocytosis or severe shaking of the blood sample, these might also lead to hyperkalemia. (The use of medications should be under the guidance of a doctor.)

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Written by Wei Shi Liang
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What are the symptoms of hyperkalemia?

The effects of hyperkalemia on the body mainly include the following aspects: First, the impact on muscle tissue: mild hyperkalemia can cause slight tremors in muscles. If the potassium levels continue to rise, this can lead to decreased neuromuscular excitability, resulting in limbs becoming weak and flaccid, and even leading to delayed paralysis. Second, the impact on the cardiac system: it can cause a decrease in myocardial excitability, conductibility, and automaticity. The electrocardiogram shows a depressed P wave, widened QRS complex, shortened QT interval, and peaked T waves. Third, hyperkalemia affects acid-base balance and can lead to metabolic acidosis during hyperkalemia.