Hypercalcemia can result in a number of changes in the electrocardiogram. These tend to become more pronounced as the serum calcium concentration increases.


The patient will have an elevated serum calcium and will show clinical manifestations of hypercalcemia.


Classic change: shortening of the QT interval (due to shortening of the duration for phase 2 of the action potential)


Additional changes that may occur:

(1) changes to the T-wave (inverted, notched, biphasic, decreased amplitude)

(2) prolonged QRS interval

(3) prolonged PR interval

(4) second or third degree atrioventricular (AV) block

(5) J wave (Osborn wave)


Reversal of the hypercalcemia should be accompanied by a correction in the ECG changes.


Differential Diagnosis:

(1) tricyclic antidepressant effect

(2) localized increase in calcium ions within the myocardium (infusion of a calcium salt, etc)


To read more or access our algorithms and calculators, please log in or register.