Arnsdorf M F
Arch Intern Med. 1976 Oct;136(10):1161-3. doi: 10.1001/archinte.1976.03630100073019.
In a patient with renal failure and shortness of breath, Q waves transiently appeared in the right precordial leads of the electrocardiogram (ECG) during episodes of hyperkalemia, without a substantial change in mean electrical axis. With restoration of the plasma potassium level to normal, R waves reappeared in these leads. It is concluded that the transient development of Q waves in the right precordial leads during hyperkalemia resulted from a hyperkalemia-induced conduction disturbance. Hyperkalemia, by affecting conduction in Purkinje fibers of ventricular muscle, or both, disturbed the normal sequence of septal and anterior wall depolarization and resulted in an ECG pattern that mimicked that of anteroseptal myocardial infarction. Clinically, hyperkalemia-induced conduction disturbances of this type must be included in the differential diagnosis of the ECG that suggests an anteroseptal myocardial infarction.
在一名患有肾衰竭且呼吸急促的患者中，高钾血症发作期间，心电图（ECG）右胸前导联短暂出现Q波，平均电轴无显著变化。随着血浆钾水平恢复正常，这些导联重新出现R波。结论是，高钾血症期间右胸前导联Q波的短暂出现是由高钾血症引起的传导障碍所致。高钾血症通过影响心室肌浦肯野纤维的传导，或两者兼而有之，扰乱了室间隔和前壁去极化的正常顺序，导致心电图模式类似于前间壁心肌梗死。临床上，这种类型的高钾血症引起的传导障碍必须纳入提示前间壁心肌梗死的心电图鉴别诊断中。
