Time-related energy distribution in hyperkalemic repolarisation

Tenting of the electrocardiogram (ECG) T wave is a known manifestation of hyperkalemia. In seeking an algorithm for the Marquette 12 SL ECG diagnostic program which would separate the hyperkalemic (HK) T wave from its simulators, the ECGs of 30 HKs were examined. They were compared with those of 25 normokalemics, and 15 pseudohyperkalemics. The most consistent feature of the hyperkalemia T was an isosceles triangulation, prototypical in V4. It was best defined in terms of height (T amp) and maximum slope of T ascent (MST). Preliminary scoring of T amp/MST and (T amp minus mid-ST amplitude)/MST confined all but 3/30 HK to respective values less than 72.5 and 64.5 ms. When used as a research tool among 4500 ECGs, these algorithms proved too sensitive to noise (38% false positive)