Lupus nephritis electrocardiogram: Difference between revisions

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{{CMG}}
{{Lupus nephritis}}
{{Lupus nephritis}}
{{CMG}}; {{AE}}[[User:Okamal|Omer Kamal, M.D.]] [mailto:okamal@bidmc.harvard.edu%7C <nowiki>[2]</nowiki>]


==Overview==
==Overview==
The most common and important [[ECG]] findings associated with systemic lupus erythematosus (SLE) include [[sinus tachycardia]], [[ST segment changes]], and [[Ventricular arrhythmias|ventricular conduction disturbances]]. Other [[ECG]] findings are related to late complications of SLE and may range based on the complication.
==Electrocardiogram==
The most common and important [[ECG]] findings associated with systemic lupus erythematosus (SLE) include [[sinus tachycardia]], [[ST segment changes]], and [[Ventricular arrhythmias|ventricular conduction disturbances]]. SLE can affect [[cardiopulmonary]] system in different ways including [[Pulmonary embolism|pulmonary emboli development]], [[Libman-Sacks disease|Libman sacks endocarditis]], and conduction problems.<ref name="pmid24838943">{{cite journal |vauthors=Bourré-Tessier J, Urowitz MB, Clarke AE, Bernatsky S, Krantz MJ, Huynh T, Joseph L, Belisle P, Bae SC, Hanly JG, Wallace DJ, Gordon C, Isenberg D, Rahman A, Gladman DD, Fortin PR, Merrill JT, Romero-Diaz J, Sanchez-Guerrero J, Fessler B, Alarcón GS, Steinsson K, Bruce IN, Ginzler E, Dooley MA, Nived O, Sturfelt G, Kalunian K, Ramos-Casals M, Petri M, Zoma A, Pineau CA |title=Electrocardiographic findings in systemic lupus erythematosus: data from an international inception cohort |journal=Arthritis Care Res (Hoboken) |volume=67 |issue=1 |pages=128–35 |year=2015 |pmid=24838943 |doi=10.1002/acr.22370 |url=}}</ref><ref name="pmid8331790">{{cite journal |vauthors=Tsunakawa H, Miyamoto N, Kawabata M, Mashima S |title=[Electrocardiogram in heart failure] |language=Japanese |journal=Nippon Rinsho |volume=51 |issue=5 |pages=1222–32 |year=1993 |pmid=8331790 |doi= |url=}}</ref><ref name="pmid20435842">{{cite journal| author=Maganti K, Rigolin VH, Sarano ME, Bonow RO| title=Valvular heart disease: diagnosis and management. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 5 | pages= 483-500 | pmid=20435842 | doi=10.4065/mcp.2009.0706 | pmc=2861980 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20435842  }}</ref><ref name="pmid14916061">{{cite journal| author=TROUNCE JR| title=The electrocardiogram in mitral stenosis. | journal=Br Heart J | year= 1952 | volume= 14 | issue= 2 | pages= 185-92 | pmid=14916061 | doi= | pmc=479442 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14916061  }}</ref><ref name="pmid7849377">{{cite journal |vauthors=Nakashima H, Honda Y, Katayama T |title=Serial electrocardiographic findings in acute myocarditis |journal=Intern. Med. |volume=33 |issue=11 |pages=659–66 |year=1994 |pmid=7849377 |doi= |url=}}</ref><ref name="pmid110701052">{{cite journal| author=Feldman AM, McNamara D|title=Myocarditis. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 19 | pages= 1388-98 | pmid=11070105 |doi=10.1056/NEJM200011093431908 | pmc= | url= }}</ref><ref name="troughton">{{cite journal | author=    Troughton RW, Asher CR, Klein AL | title=    Pericarditis | journal=  Lancet| year=2004| pages=717–27 | volume=363 | issue=9410 | pmid=15001332 | doi=    10.1016/S0140-6736(04)15648-1}}</ref><ref name="spodick">{{cite journal | author=  Spodick DH | title= Acute pericarditis: current concepts and practice | journal= JAMA | year=2003 | pages=1150–3 | volume=289 | issue=9 | pmid=12622586 | doi= 10.1001/jama.289.9.1150}}</ref>
=== Important ECG findings in SLE patients based on cardiac complication: ===
{| class="wikitable"
| colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Cardiac complication
| align="center" style="background: #4479BA; color: #FFFFFF; " |ECG findings
| align="center" style="background: #4479BA; color: #FFFFFF; " |ECG examples
|-
| colspan="2" style="background: #DCDCDC; " |[[Cardiomegaly]]
|
* Increase in [[QRS complex|QRS]] amplitude
* Widened [[QRS]]/T angle
* [[Left Atrial Enlargement|Left atrial enlargement]]
* [[Left axis deviation]]
|[[File:LA.gif|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]
|-
| rowspan="2" style="background: #DCDCDC; " |[[Libman-Sacks endocarditis|Libman sacks endocarditis]]
| style="background: #DCDCDC; " |[[Heart failure]]
|
* [[P wave]] changes
* [[R wave]] height changes
** Primary increase
** Decrease after progression
|[[File:Jjj.gif|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]
|-
| style="background: #DCDCDC; " |[[Myocardial infarction]]
|
* Due to [[emboli]]
**[[ST elevation]] of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in  V2–V3 and/or of 1 mm (0.1mV) in 2 contiguous chest leads or limb leads
**[[ST depression]] in at least two [[precordial leads]] V1-V4 (suggestive of [[posterior MI]])
**[[ST depression]] in several leads plus [[ST elevation]] in lead aVR (suggestive of occlusion of the left main or proximal [[LAD artery]])
**New [[left bundle branch block]] ([[LBBB]])
|[[File:84 Acute inf STEMI.jpg|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]
|-
| rowspan="2" style="background: #DCDCDC; " |[[Valvular Diseases|Valvular involvement]]
| style="background: #DCDCDC; " |[[Mitral stenosis|Mitral valve stenosis]]
|
* [[ECG]] findings suggestive of [[left atrial enlargement]] include:
**Broad and biphasic [[P wave]] in lead II ([[P mitrale]])
**Enlargement of the terminal negative portion of the [[P wave]] in VI
**[[P wave]] amplitude >2.5 mm in inferior leads (II, III, AVF) or >1.5 mm in V1/V2 ([[P pulmonale]])
|[[File:LA.gif|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]
|-
| style="background: #DCDCDC; " |[[Mitral regurgitation]]
|
* [[ECG]] findings suggestive of [[left atrial enlargement]] include:
**Broad and biphasic [[P wave]] in lead II [[P mitrale|(P mitrale)]]
**Enlargement of the terminal negative portion of the [[P wave]] in V1
**[[P wave]] amplitude >2.5 mm in inferior leads (II, III, AVF) or >1.5 mm in V1/V2 (P pulmonale)
*[[ECG]] findings suggestive of [[left ventricular enlargement]] include:
**Increased [[QRS]] voltage on [[ECG]]
**Strain pattern
**Inverted check mark pattern to the [[T wave]] in the lateral leads
|[[File:80 RVH and LAE in mitral stenosis.jpg|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]
|-
| rowspan="2" style="background: #DCDCDC; " |[[Arrythmias|Arrhythmias]]
| style="background: #DCDCDC; " |[[Atrioventricular block|AV Blocks]]
|
* Incomplete [[bundle branch block]]
* [[Right bundle branch block]]
* [[Left bundle branch block]]
* [[Left anterior fascicular block]]
* [[Left posterior fascicular block]]
|[[File:Ggddh.gif|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]<br>
[[File:80 RVH and LAcxE in mitral stenosis.jpg|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]
|-
| style="background: #DCDCDC; " |[[Supraventricular arrhythmias]]
|
* [[Premature atrial contraction|Premature atrial complexes]] (PAC)
* [[Atrial fibrillation]]
* [[Atrial flutter]]
|[[File:Pac.jpg|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]
|-
| rowspan="2" style="background: #DCDCDC; " |[[Pericardial disease]]
| style="background: #DCDCDC; " |[[Acute pericarditis]]
|
*[[ST segment]] depression:
**Always in [[aVR]]
**Frequently in V1
**Occasionally in V2
*[[J point]] in V6 > 25% of the height of the [[T waves|T wave apex]]
*Reduced voltage with quasi-specific ST-T waves due to increase in [[scar tissue]], fluid and [[fibrin]]
*The [[EKG]] abnormalities vary depending on the stage/severity of the [[pericarditis]]
|[[File:Ecg 12lead006z.gif|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]
|-
| style="background: #DCDCDC; " |[[Pericardial effusion]]
|
* [[Electrical alternans]]
** An [[Electrocardiogram|electrocardiographic]] phenomenon of alternation of [[QRS complex]] amplitude or [[axis]] between beats
|[[File:Electrical Alternans.jpg|200px|thumb|'''https://en.wikipedia.org/wiki/Pericardial_effusion''' Courtesy dedicated to wikipedia]]
|-
| colspan="2" style="background: #DCDCDC; " |[[Myocarditis]]
|
The [[Electrocardiogram|ECG]] findings most commonly seen in [[myocarditis]] are:
*[[Sinus tachycardia]]
*Diffuse [[T wave]] inversions
*[[ST segment elevation]] without reciprocal depression
*Low voltage of the [[QRS]] complexes
*[[Arrhythmias]] such as [[atrial]] or [[ventricular]] ectopic beats, [[atrial]] or [[Ventricular Tachycardia|ventricular tachycardias]], and [[atrial fibrillation]]
|[[File:PericarditisMyocarditis.jpg|200px|thumb|'''https://en.wikipedia.org/wiki/Myocarditis''' Courtesy dedicated to wikipedia]]
|-
| colspan="2" style="background: #DCDCDC; " |[[Coronary heart disease|Coronary artery disease]]
|
* Exercise tolerance test findings include:
** [[ST segment changes]]
** Exercise induced [[ventricular arrhythmia]]
** [[Hemodynamics|Hemodynamic]] changes during the test
|[[File:Jkhhk.jpg|200px|thumb|'''http://ecg.utah.edu/img_index''' Courtesy dedicated to ecg.utah.edu]]
|}


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
 
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{{WH}}
{{WS}}
{{WS}}
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Latest revision as of 17:30, 20 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D. [2]

Overview

The most common and important ECG findings associated with systemic lupus erythematosus (SLE) include sinus tachycardia, ST segment changes, and ventricular conduction disturbances. Other ECG findings are related to late complications of SLE and may range based on the complication.

Electrocardiogram

The most common and important ECG findings associated with systemic lupus erythematosus (SLE) include sinus tachycardia, ST segment changes, and ventricular conduction disturbances. SLE can affect cardiopulmonary system in different ways including pulmonary emboli development, Libman sacks endocarditis, and conduction problems.[1][2][3][4][5][6][7][8]

Important ECG findings in SLE patients based on cardiac complication:

Cardiac complication ECG findings ECG examples
Cardiomegaly
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Libman sacks endocarditis Heart failure
  • P wave changes
  • R wave height changes
    • Primary increase
    • Decrease after progression
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Myocardial infarction
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Valvular involvement Mitral valve stenosis
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Mitral regurgitation
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Arrhythmias AV Blocks
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu

http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Supraventricular arrhythmias
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Pericardial disease Acute pericarditis
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Pericardial effusion
https://en.wikipedia.org/wiki/Pericardial_effusion Courtesy dedicated to wikipedia
Myocarditis

The ECG findings most commonly seen in myocarditis are:

https://en.wikipedia.org/wiki/Myocarditis Courtesy dedicated to wikipedia
Coronary artery disease
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu

References

  1. ↑ Bourré-Tessier J, Urowitz MB, Clarke AE, Bernatsky S, Krantz MJ, Huynh T, Joseph L, Belisle P, Bae SC, Hanly JG, Wallace DJ, Gordon C, Isenberg D, Rahman A, Gladman DD, Fortin PR, Merrill JT, Romero-Diaz J, Sanchez-Guerrero J, Fessler B, Alarcón GS, Steinsson K, Bruce IN, Ginzler E, Dooley MA, Nived O, Sturfelt G, Kalunian K, Ramos-Casals M, Petri M, Zoma A, Pineau CA (2015). "Electrocardiographic findings in systemic lupus erythematosus: data from an international inception cohort". Arthritis Care Res (Hoboken). 67 (1): 128–35. doi:10.1002/acr.22370. PMID 24838943.
  2. ↑ Tsunakawa H, Miyamoto N, Kawabata M, Mashima S (1993). "[Electrocardiogram in heart failure]". Nippon Rinsho (in Japanese). 51 (5): 1222–32. PMID 8331790.
  3. ↑ Maganti K, Rigolin VH, Sarano ME, Bonow RO (2010). "Valvular heart disease: diagnosis and management". Mayo Clin Proc. 85 (5): 483–500. doi:10.4065/mcp.2009.0706. PMC 2861980. PMID 20435842.
  4. ↑ TROUNCE JR (1952). "The electrocardiogram in mitral stenosis". Br Heart J. 14 (2): 185–92. PMC 479442. PMID 14916061.
  5. ↑ Nakashima H, Honda Y, Katayama T (1994). "Serial electrocardiographic findings in acute myocarditis". Intern. Med. 33 (11): 659–66. PMID 7849377.
  6. ↑ Feldman AM, McNamara D (2000). "Myocarditis". N Engl J Med. 343 (19): 1388–98. doi:10.1056/NEJM200011093431908. PMID 11070105.
  7. ↑ Troughton RW, Asher CR, Klein AL (2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.
  8. ↑ Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.

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