Exp Clin Cardiol. 2010;15(4):e96-9.
Hypokalemia and sudden cardiac death.
Experimental and clinical cardiology
Keld Kjeldsen
Affiliations
Affiliations
- Laboratory for Molecular Cardiology, Medical Department B, The Heart Centre, Copenhagen University Hospital (Rigshospitalet) and Danish National Research Foundation Centre for Cardiac Arrhythmia, University of Copenhagen, Copenhagen, Denmark.
PMID: 21264075
PMCID: PMC3016067
Abstract
Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient reductions in plasma potassium concentration are of importance. Hypokalemia is present in 7% to 17% of patients with cardiovascular disease. Furthermore, up to 20% of hospitalized patients and up to 40% of patients on diuretics suffer from hypokalemia. Importantly, inadequate management of hypokalemia was found in 24% of hospitalized patients. Hypokalemia is associated with increased risk of arrhythmia in patients with cardiovascular disease, as well as increased all-cause mortality, cardiovascular mortality and heart failure mortality by up to 10-fold. Long-term potassium homeostasis depends on renal potassium excretion. However, skeletal muscles play an important role in short-term potassium homeostasis, primarily because skeletal muscles contain the largest single pool of potassium in the body. Moreover, due to the large number of Na(+)/K(+) pumps and K(+) channels, the skeletal muscles possess a huge capacity for potassium exchange. In cardiovascular patients, hypokalemia is often caused by nonpotassium-sparing diuretics, insufficient potassium intake and a shift of potassium into stores by increased potassium uptake stimulated by catecholamines, beta-adrenoceptor agonists and insulin. Interestingly, drugs with a proven significant positive effect on mortality and morbidity rates in heart failure patients all increase plasma potassium concentration. Thus, it may prove beneficial to pay more attention to hypokalemia and to maintain plasma potassium levels in the upper normal range. The more at risk of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis.
Keywords: Arrhythmia; Hypokalemia; Na+/K+-ATPase; Potassium; Sudden cardiac death
References
- Am J Physiol Cell Physiol. 2004 Jul;287(1):C135-41 - PubMed
- Heart. 2003 Jan;89(1):31-5 - PubMed
- N Engl J Med. 1994 Jun 30;330(26):1852-7 - PubMed
- Br Heart J. 1983 Dec;50(6):525-9 - PubMed
- Kidney Int. 1990 Nov;38(5):869-72 - PubMed
- Acta Physiol Scand. 1984 Oct;122(2):103-17 - PubMed
- Br J Clin Pharmacol. 1987 Nov;24(5):645-53 - PubMed
- Lancet. 1990 Dec 8;336(8728):1396-9 - PubMed
- Diabetes. 2003 Jun;52(6):1469-74 - PubMed
- Pharmacotherapy. 2005 Sep;25(9):1266-70 - PubMed
- Int J Cardiol. 1991 Sep;32(3):331-8 - PubMed
- Hypertension. 2000 May;35(5):1025-30 - PubMed
- Scand J Clin Lab Invest. 1979 Apr;39(2):167-70 - PubMed
- Int J Cardiol. 2010 May 28;141(2):167-74 - PubMed
- J Appl Physiol (1985). 1995 Jan;78(1):172-8 - PubMed
- J Clin Invest. 1964 May;43:950-62 - PubMed
- Clin Sci (Lond). 1993 Sep;85(3):327-35 - PubMed
- Resuscitation. 2006 Jul;70(1):10-25 - PubMed
- Arch Intern Med. 2001 Apr 23;161(8):1089-95 - PubMed
- Am J Physiol. 1991 May;260(5 Pt 1):C958-64 - PubMed
- Br Heart J. 1987 Dec;58(6):572-82 - PubMed
- Am J Med. 1981 Apr;70(4):762-8 - PubMed
- N Engl J Med. 1999 Sep 2;341(10):709-17 - PubMed
- Acta Med Scand. 1988;224(6):531-7 - PubMed
- J Hypertens. 2001 Jul;19(7):1315-23 - PubMed
- Am Heart J. 1985 Nov;110(5):944-8 - PubMed
- Chest. 2004 Jun;125(6):2309-21 - PubMed
- Fundam Clin Pharmacol. 2010 Oct;24(5):535-7 - PubMed
- J Am Coll Cardiol. 2004 Jan 21;43(2):155-61 - PubMed
- Circulation. 2008 Oct 14;118(16):1643-50 - PubMed
- Fundam Clin Pharmacol. 2010 Oct;24(5):547-59 - PubMed
- Circulation. 1985 Apr;71(4):645-9 - PubMed
- Nature. 1981 Oct 29;293(5835):739-41 - PubMed
- Circ Heart Fail. 2010 Mar;3(2):253-60 - PubMed
- Metabolism. 1995 Jan;44(1):119-25 - PubMed
- Br J Clin Pharmacol. 1980 May;9(5):483-91 - PubMed
- Am J Physiol Renal Physiol. 2001 Jan;280(1):F95-F102 - PubMed
- Fundam Clin Pharmacol. 2010 Oct;24(5):595-605 - PubMed
- Medicine (Baltimore). 1985 Sep;64(5):323-32 - PubMed
- N Engl J Med. 1998 Aug 13;339(7):451-8 - PubMed
- Acta Med Scand Suppl. 1981;647:67-73 - PubMed
- Am Heart J. 1989 Sep;118(3):642-8 - PubMed
- Eur Heart J. 2007 Jun;28(11):1334-43 - PubMed
- Eur J Pharmacol. 1985 Jul 31;113(3):373-82 - PubMed
- Lancet. 2003 Sep 6;362(9386):777-81 - PubMed
- Br Med J (Clin Res Ed). 1988 Feb 13;296(6620):455-8 - PubMed
- J Physiol. 1977 Sep;270(2):383-414 - PubMed
- Br Med J (Clin Res Ed). 1981 Jun 13;282(6280):1932 - PubMed
- J Physiol. 1977 Feb;265(1):19-42 - PubMed
- Am J Med. 1982 Aug;73(2):155-9 - PubMed
- Am J Physiol Cell Physiol. 2006 May;290(5):C1355-63 - PubMed
- J Clin Invest. 1930 Apr;8(3):325-35 - PubMed
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