EKG shows one thing, blood test another

[kmichaelson]

Hi everyone,

I passed out last week in a public place, and the business owner called 911. My blood pressure was 50-something over 30-something, and I guess my lips were blue, so the EMTs did an EKG on me. They told me that the EKG results showed my potassium was too high and my sodium too low, which they called hyperkalemia. I told my primary care doctor about this, and he didn't seem to take my word for it (which is a whole other story!) and ordered a blood test to check my electrolytes. The blood test showed my potassium and sodium are within normal ranges. I had the blood test more than a week after the EKG, so that could be the issue. However, I wonder if anyone else here has had a similar experience where your EKG shows one thing but your blood test doesn't back it up? I'm just not sure which test to believe. I'm also not sure if it's possible to get any documentation of my EKG to show my doctor. 

What's really frustrating is that I want my doctor to order saline IVs for my POTS, but he seems unwilling to do so without the blood test showing low sodium. I know there's documentation that shows saline IVs are helpful for people with POTS due to low blood volume, but I'm kind of tired of fighting him. It seems like every time I try to explain something to him, it just convinces him more that I'm a hypochondriac, especially when the tests don't back up what I'm telling him. I also tried to get a saline IV from a medispa, but the doctor who consults for them wouldn't sign off on it because I'd been passing out... that's why I ended up going to my PC doc for blood tests! Ugh.

[MikeO]

Well @kmichaelsonkeep in mind low blood pressure is not a symptom of POTS but tachycardia without a drop in BP and dizziness is. with that low of a BP i would be looking elsewhere. I also go low and is not POTS mediated. I have looked at IV infusions but they will not fix my issue IMO.

Stick with it as there is more stressors that affect BP's or have another origin.

Wish you the best!   

[dkd]

I don't know how an EKG would show the status of your sodium and potassium.  Maybe they were speculating?? Blood test is the only way to know.

[RecipeForDisaster]

Potassium highs or lows do actually show up on EKG, but people can misinterpret these signs. And yes, it’s possible that the imbalance was corrected before you had the bloodwork.

 

Low sodium is not normally a reason why we’d get infusions of saline, LR, etc. I actually do have low sodium, but most people like me don’t. It’s just a blood volume helper in my case. It basically gets me out of shock for a bit. It sounds like your doctor isn’t that supportive or knowledgeable, unfortunately. It CAN be difficult to get IV hydration prescribed, and I don’t think it’s right for most people as a regular treatment. It's close to a last resort for me - I’m on a ton of other meds and interventions.

[Pistol]

Dear @kmichaelson here is an article and a excerpt from it explaining that there are very typical changes in a EKG related to hyperkalemia ( high potassium ). 

https://emedicine.medscape.com/article/240903-workup#:~:text=ECG changes have a sequential,%3B and ST-segment depression.

ECG changes have a sequential progression, which roughly correlate with the potassium level. Early changes of hyperkalemia include tall, peaked T waves with a narrow base, best seen in precordial leads ; shortened QT interval; and ST-segment depression.

With the fact that you had a syncopal event, EKG changes and low BP it would have been realistic to take you to the ER for evaluation, blood work and yes - IV fluids. 

[kmichaelson]

Thanks to all of you for this information! It's so helpful to get others' perspectives on this. @Pistol, thanks so much for the link to that article. I should have mentioned that I was diagnosed with POTS about twelve years ago, but I had low blood pressure on my tilt table rather than high blood pressure. However, since I passed out, the doctor I had at that time, said I had POTS. A subsequent doctor said it wasn't POTS, but some other kind of dysautonomia. Recently, I've been having daily POTS symptoms--shortness of breath, weakness, fatigue, blacking out when standing, exercise intolerance--all that good stuff. That's why I'm hoping IVs would help me, especially as I try to gradually increase the amount of exercise I do.

@MikeO, I'm curious if you have figured out the type of dysautonomia you have since you have low blood pressure too?

 

[MikeO]

8 minutes ago, kmichaelson said:

@MikeO, I'm curious if you have figured out the type of dysautonomia you have since you have low blood pressure too?

OH/nOH and postprandial hypotension and some sort of autonomic dysfunction is the best i have been told and the specialist won't even pin down the subtype of the OH. Unfortunately autonomic testing is very hard to get done in wisconsin if at all anymore. 

[Pistol]

7 hours ago, kmichaelson said:

but I had low blood pressure on my tilt table rather than high blood pressure. However, since I passed out, the doctor I had at that time, said I had POTS. A subsequent doctor said it wasn't POTS, but some other kind of dysautonomia.

Have you looked into NCS - neurocardiogenic syncope? It is a dysautonomic dysfunction. If you check under the information tab on the top of our homepage you can find some info on this. 

[kmichaelson]

Thanks @Pistol. I looked into NCS long ago when I was first learning about dysautonomia, but it's been a very long time. I'll check out the information you mentioned since I know low BP would fit with that. Thanks again!