Hypercalcaemia ECG changes

ECG Changes in Hypercalcaemia

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Hypercalcaemia Overview

• Normal serum corrected calcium = 2.1 – 2.6 mmol/L
• Mild hypercalcaemia = 2.7 – 2.9 mmol/L
• Moderate hypercalcaemia = 3.0 – 3.4 mmol/L
• Severe hypercalcaemia = greater than 3.4 mmol/L

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Causes of Hypercalcaemia

• Hyperparathyroidism (primary and tertiary)
• Myeloma
• Bony metastases
• Paraneoplastic syndromes
• Milk-alkali syndrome
• Sarcoidosis
• Excess vitamin D (e.g. iatrogenic)

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ECG Examples

Example 1

Hypercalcaemia

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Example 2

• Hypercalcaemia causing marked shortening of the QT interval (260ms).
• Image originally featured in Kyuhyun (K.) Wang’s excellent Atlas of Electrocardiography

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Example 3

This is the ECG of a 41-year old man with a parathyroid adenoma who presented to ED critically unwell with a serum calcium of 6.1 mmol/L. He suffered a VF arrest not long after this ECG was taken. The ECG shows:

• Bizarre-looking QRS complexes
• Very short QT interval
• J waves = notching of the terminal QRS, best seen in lead V1

Many thanks to Dr James Hayes, FACEM, for this fantastic ECG!

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References

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Advanced Reading

Online

Textbooks

• Zimmerman FH. ECG Core Curriculum. 2023
• Mattu A, Berberian J, Brady WJ. Emergency ECGs: Case-Based Review and Interpretations, 2022
• Straus DG, Schocken DD. Marriott’s Practical Electrocardiography 13e, 2021
• Brady WJ, Lipinski MJ et al. Electrocardiogram in Clinical Medicine. 1e, 2020
• Mattu A, Tabas JA, Brady WJ. Electrocardiography in Emergency, Acute, and Critical Care. 2e, 2019
• Hampton J, Adlam D. The ECG Made Practical 7e, 2019
• Kühn P, Lang C, Wiesbauer F. ECG Mastery: The Simplest Way to Learn the ECG. 2015
• Grauer K. ECG Pocket Brain (Expanded) 6e, 2014
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008
• Chan TC. ECG in Emergency Medicine and Acute Care 1e, 2004

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LITFL Further Reading

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