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ECG in Hypocalcemia
ECG findings
QT interval is prolonged due to ST segment prolongation.
T wave alternans (rare).
ST segment elevation (rare, may mimick acute myocardial infarction).
Sensitivity and specificity of ECG findings of hypocalcemia are not high.
Failure to observe anticipated ECG findings does not necessarily rule out the possibility of hypocalcemia.
Chronic hypocalcemia may result in dilated cardiomyopathy (left ventricular failure).
References (including links to sample ECGs)
Eur J Heart Fail 2001;3(3):373-376.
Pan Afr Med J. 2014 Jan 27;17:65.
J Zhejiang Univ Sci B 2014;15(6):598-600.
Clin Cardiol. 2010 Feb;33(2):E72-75..
Chest 2000 Jul;118(1):260-262.
Am J Emerg Med 2012;30(1):256.e3-6.
J Neurosci Rural Pract 2016;7(Suppl 1):S117-S119.
Korean J Intern Med 2013;28(5):605-608.
ECG 1a. The above ECG belongs to a patient with serum levels of calcium 6.5 mg/dL, potassium 5.1 mmol/L and creatinine
4.1 mg/dL.
Click here for a more detailed ECG
ECG 1b. The ECG of the same patient was recorded at a calibration of 20mm/mV to see the details more clearly.
Click here for a more detailed ECG
ECG 2a. The above ECG belongs to a chronic renal failure patient who refused hemodialysis for the last 10 days. When the
above ECG was recorded, his serum potassium was level 9mmol/L and serum calcium level was 7.8 mg/dL. His ECG shows
evidence of hyperkalemia and hypocalcemia: Increased T wave amplitude , decreased P wave amplitude and widening of
the QRS complex suggest hyperkalemia. Prolongation of the ST segment resulting in increased QT interval suggests
hypocalcemia.
Dr. Isik Sonmez has donated the above ECG to our website.
Click here for a more detailed ECG
EKG 2b. The above ECG belongs to the same patient and was recorded after hemodialysis. This time, his serum potassium
level was 4.6 mmol/L and his serum calcium level was 10.5 mg/dL. After normalization of the serum potassium level T wave
amplitude decreased , P wave amplitude increased and QRS widening disappeared. Normalization of the serum calcium level
resulted in the disappearance of ST segment prolongation .
Dr. Isik Sonmez has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 3. The ECG above belongs to a 37 years-old woman with chronic renal failure.
On the same day, her serum potassium level was 5.7mmol/L, serum calcium level was 7.8 mg/dL.
This ECG suggests hypocalcemia.
Prolongation of the ST segment resulted in increased QT interval.
Click here for a more detailed ECG
ECG findings
QT interval is prolonged due to ST segment prolongation.
T wave alternans (rare).
ST segment elevation (rare, may mimick acute myocardial infarction).
Sensitivity and specificity of ECG findings of hypocalcemia are not high.
Failure to observe anticipated ECG findings does not necessarily rule out the possibility of hypocalcemia.
Chronic hypocalcemia may result in dilated cardiomyopathy (left ventricular failure).
References (including links to sample ECGs)
Eur J Heart Fail 2001;3(3):373-376.
Pan Afr Med J. 2014 Jan 27;17:65.
J Zhejiang Univ Sci B 2014;15(6):598-600.
Clin Cardiol. 2010 Feb;33(2):E72-75..
Chest 2000 Jul;118(1):260-262.
Am J Emerg Med 2012;30(1):256.e3-6.
J Neurosci Rural Pract 2016;7(Suppl 1):S117-S119.
Korean J Intern Med 2013;28(5):605-608.
ECG 1a. The above ECG belongs to a patient with serum levels of calcium 6.5 mg/dL, potassium 5.1 mmol/L and creatinine
4.1 mg/dL.
Click here for a more detailed ECG
ECG 1b. The ECG of the same patient was recorded at a calibration of 20mm/mV to see the details more clearly.
Click here for a more detailed ECG
ECG 2a. The above ECG belongs to a chronic renal failure patient who refused hemodialysis for the last 10 days. When the
above ECG was recorded, his serum potassium was level 9mmol/L and serum calcium level was 7.8 mg/dL. His ECG shows
evidence of hyperkalemia and hypocalcemia: Increased T wave amplitude , decreased P wave amplitude and widening of
the QRS complex suggest hyperkalemia. Prolongation of the ST segment resulting in increased QT interval suggests
hypocalcemia.
Dr. Isik Sonmez has donated the above ECG to our website.
Click here for a more detailed ECG
EKG 2b. The above ECG belongs to the same patient and was recorded after hemodialysis. This time, his serum potassium
level was 4.6 mmol/L and his serum calcium level was 10.5 mg/dL. After normalization of the serum potassium level T wave
amplitude decreased , P wave amplitude increased and QRS widening disappeared. Normalization of the serum calcium level
resulted in the disappearance of ST segment prolongation .
Dr. Isik Sonmez has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 3. The ECG above belongs to a 37 years-old woman with chronic renal failure.
On the same day, her serum potassium level was 5.7mmol/L, serum calcium level was 7.8 mg/dL.
This ECG suggests hypocalcemia.
Prolongation of the ST segment resulted in increased QT interval.
Click here for a more detailed ECG