Haan, Dieter
March 1966
Angiology;Mar1966, Vol. 17 Issue 3, p176
Academic Journal
In 81 patients with moderate to severe cardiac insufficiency of varying etiology, potassium and sodium levels in the erythrocytes and serum were continually checked, before treatment was begun, and during substitution therapy with potassium. At the same time, electrocardiograms were recorded, in order to determine whether typical ECG changes of hypokalemia could be observed in these patients. A lowering of the red cell K occurred in 48.1 per cent, and that of serum K in 33.3 per cent. Elevation of red cell K was never observed, and that of serum K in 1.2 per cent. Red cell Na was lowered in 3.7 per cent, that of serum Na in 7.4 per cent. Red cell Na was elevated in 14.8 per cent, that of serum Na in 3.7 per cent. The results of these investigations indicate an intra- and extracellular potassium deficiency, and an intracellular excess of sodium in chronic cardiac insufficiency. Since the inflow of sodium is essential for the onset of stimulation of cardiac muscle action, and the outflow of potassium is essential for ending this stimulation, it is our opinion that both the transmembrane K+ gradient and the transmembrane Na+ gradient are of great significance for the ECG tracing. However, in the clinical field, determination of these myocardial electrolyte quotients is impossible. Therefore, we have tentatively taken the sodium and potassium levels in the serum as extracellular and in the erythrocytes as intracellular values, and have established a quotient. This quotient was tentatively related to ECG changes, whereby we arrived at the following results: with raised quotient, the hypokalemic type of ECG occurred in 16.04 per cent, ST depression in 6.17 per cent. With a lowered quotient, the hypokalemic type of ECG was present in 3.7 per cent, and ST depressions in 29.63 per cent. With a normal quotient, the hypokalemic type was found in 2.5 per cent, and ST depressions in 12.34 per cent. In the remaining 24 cases, there were no ST-T-U abnormalities. The displacements were statistically significant. In every type of chronic cardiac insufficiency, electrolyte changes in serum and erythrocytes relatively frequently run parallel to the corresponding ECG alterations. However, one must not draw the conclusion from this that electrolyte relationships in serum and erythrocytes are representative of the electrolyte gradients of the myocardium. Substitution therapy with a potassium product was successful in 43 out of 59 patients. In addition, the clinical signs of digitalis overdose and digitalis induced disturbances of rhythm were remedied in 23 out of 31 cases, without the dose of digitalis being reduced.


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