Sodium ion concentration:

Normal level is 135-145 mEq/L Na+ in the body fluid reduces the electrical activity of the cardiac muscle. ECG shows low voltage waves.

Potassium ion concentration:

Normal level is 3.5 - 5 mEq/L. ECG changes develops when the K+ to 6 mEq/L

K+ to 2mEq/L

Hyperkalemia decreases Resting membrane potential & leads to hyperpolarisation. Excitability of the muscle

1.

2.

The effect of hyperkalemia on the excitability of cardiac muscle depend upon the severity of hyperkalemia.
1.

K+ ses to 6 or 7 mEq/L, in ECG T wave is tall & tented. P-R interval and QRS complex are normal.
K+ ses to 8mEq/L. P-R interval and duration of QRS complex prolonged . P wave may be small.

2.

3.When the K+ ses beyond 9 mEq/L a) atrial muscle becomes unexcitable . So in the ECG P wave is absent .

b) The QRS complex merges with the T wave. c) this condition leads to ventricullar fibrillation or stoppage of heart in diastole due to lack of excitability. So fatal.

Hypokalemia decreases the sensitivity of heart muscle.

When K+ level falls to 2 mEq/L , ECG shows

a) S-T segment depression. b) small, flat or inverted T-wave. c) U-wave which merges with the T wave.

When K+ level ses below 2 mEq/L, there will be a) depression of S-T segment below the isoelectric baseline. b) inversion of T-wave.
c) appearance of prominent U- wave. d) prolongation of P-R interval.

Calcium ion concentration :

Normal Ca2+ concentration in blood is 9 11mg/dL. Hypocalcemia affects the heart rather than the hypercalcemia.

Hypercalcemia ses the excitability & contractility of heart muscle. Changes in the ECG are 1. shortening of duration of S-T segment. 2. shortening of Q-T interval.

3. appearance of U wave.

Hypocalcemia ses the excitability of the cardiac muscle. Changes in the ECG are 1. prolongation of S-T segment.

2. prolongation of Q-T interval.

3. appearance of prominent U- wave.