Systemic lupus erythematosus electrocardiogram: Difference between revisions

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==Overview==
==Overview==
The most important and prevalent ECG findings associated with systemic lupus erythematosus (SLE) include sinus tachycardia, ST segment changes, and ventricular conduction disturbances.  
The most important and prevalent [[ECG]] findings associated with systemic lupus erythematosus (SLE) include [[sinus tachycardia]], [[ST segment changes]], and [[Ventricular arrhythmias|ventricular conduction disturbances]].  


==Electrocardiogram==
==Electrocardiogram==
The most important and prevalent ECG findings associated with systemic lupus erythematosus (SLE) include sinus tachycardia, ST segment changes, and ventricular conduction disturbances. SLE can affect cardiaopulmonary system in different ways including pulmonary emboli development, 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>
The most important and prevalent [[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>


=== Important ECG findings in SLE patients based on prevalance: ===
=== Important ECG findings in SLE patients based on prevalance: ===
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| colspan="2" style="background: #DCDCDC; " |[[Cardiomegaly]]
| colspan="2" style="background: #DCDCDC; " |[[Cardiomegaly]]
|
|
* ≥ QRS amplitude
* ≥ [[QRS complex|QRS]] amplitude
* Widened QRS/T angle
* Widened [[QRS]]/T angle
* Left Atrial Enlargement in V1
* [[Left Atrial Enlargement]] in V1
* Left axis deviation
* [[Left axis deviation]]
|-
|-
| rowspan="2" style="background: #DCDCDC; " |Libman sachs endocarditis
| rowspan="2" style="background: #DCDCDC; " |[[Libman-Sacks endocarditis|Libman sacks endocarditis]]
| style="background: #DCDCDC; " |[[Heart failure]]<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>
| style="background: #DCDCDC; " |[[Heart failure]]<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>
|
|
* P wave changes
* [[P wave]] changes
* R wave height changes
* [[R wave]] height changes
** Primary increase
** Primary increase
** Decrease after progression
** Decrease after progression
Line 31: Line 31:
| style="background: #DCDCDC; " |[[Myocardial infarction]]
| style="background: #DCDCDC; " |[[Myocardial infarction]]
|
|
* Due to emboli
* Due to [[emboli]]
**[[ST elevation]] in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1mV) in other contiguous chest leads or the limb leads
**[[ST elevation]] in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1mV) in other contiguous chest leads or the limb leads
**[[ST depression]] in at least two precordial leads V1-V4 (suggestive of [[posterior MI]])
**[[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]])
**[[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]])
**New [[left bundle branch block]] ([[LBBB]])
|-
|-
| rowspan="2" style="background: #DCDCDC; " |Valvular involvement <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>
| rowspan="2" style="background: #DCDCDC; " |[[Valvular Diseases|Valvular involvement]] <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>
| style="background: #DCDCDC; " |[[Mitral stenosis|Mitral valve stenosis]]
| style="background: #DCDCDC; " |[[Mitral stenosis|Mitral valve stenosis]]
|
|
* ECG findings suggestive of [[left atrial enlargement]] include:
* [[ECG]] findings suggestive of [[left atrial enlargement]] include:
**Broad, bifid [[P wave]] in lead II (P mitrale)
**Broad, bifasic [[P wave]] in lead II ([[P mitrale]])
**Enlargement of the terminal negative portion of the P wave in VI
**Enlargement of the terminal negative portion of the [[P wave]] in VI
**P wave amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 (P pulmonale)
**[[P wave]] amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 ([[P pulmonale]])
|-
|-
| style="background: #DCDCDC; " |[[Mitral regurgitation]]
| style="background: #DCDCDC; " |[[Mitral regurgitation]]
|
|
* ECG findings suggestive of [[left atrial enlargement]] include:
* [[ECG]] findings suggestive of [[left atrial enlargement]] include:
**Broad, bifid [[P wave]] in lead II (P mitrale)
**Broad, bifasic [[P wave]] in lead II [[P mitrale|(P mitrale)]]
**Enlargement of the terminal negative portion of the P wave in VI
**Enlargement of the terminal negative portion of the [[P wave]] in V1
**P wave amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 (P pulmonale)
**[[P wave]] amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 (P pulmonale)
*ECG findings suggestive of left ventricular enlargement include:
*[[ECG]] findings suggestive of [[left ventricular enlargement]] include:
**Increased [[QRS]] voltage on ECG
**Increased [[QRS]] voltage on [[ECG]]
**Strain pattern
**Strain pattern
**Inverted check mark pattern to the T wave in the lateral leads
**Inverted check mark pattern to the [[T wave]] in the lateral leads
|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Arrythmias|aArrythmias]]
| rowspan="2" style="background: #DCDCDC; " |[[Arrythmias|aArrythmias]]
| style="background: #DCDCDC; " |[[Cardiac arrhythmia|Ventricular arryhthmias]]
| style="background: #DCDCDC; " |[[Cardiac arrhythmia|Ventricular arryhthmias]]
|
|
* Incomplete bundle branch block
* Incomplete [[bundle branch block]]
* [[Right bundle branch block]]
* [[Right bundle branch block]]
* [[Left bundle branch block]]
* [[Left bundle branch block]]
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*Typical lead involvement: I, II, aVL, aVF, and V3-V6
*Typical lead involvement: I, II, aVL, aVF, and V3-V6
*The [[ST segment]] depression:
*The [[ST segment]] depression:
**Always in aVR
**Always in [[aVR]]
**Frequently in V1
**Frequently in V1
**Occasionally in V2
**Occasionally in V2
*J point in V6 > 25% of the height of the T wave apex  
*[[J point]] in V6 > 25% of the height of the [[T waves|T wave apex]]
*Reduce voltage with quasi-specific ST-T waves due to increase in scar tissue, fluid and [[fibrin]]
*Reduce voltage with quasi-specific ST-T waves due to increase in [[scar tissue]], fluid and [[fibrin]]
*Yhe [[EKG]] abnormalities vary depending on the stage/severity of the [[pericarditis]]
*The [[EKG]] abnormalities vary depending on the stage/severity of the [[pericarditis]]
|-
|-
| style="background: #DCDCDC; " |[[Pericardial effusion]]
| style="background: #DCDCDC; " |[[Pericardial effusion]]
|
|
* [[Electrical alternans]]
* [[Electrical alternans]]
** An [[Electrocardiogram|electrocardiographic]] phenomenon of alternation of [[QRS complex]] amplitude or axis between beats
** An [[Electrocardiogram|electrocardiographic]] phenomenon of alternation of [[QRS complex]] amplitude or [[axis]] between beats
|-
|-
| colspan="2" style="background: #DCDCDC; " |[[Myocarditis]]<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>
| colspan="2" style="background: #DCDCDC; " |[[Myocarditis]]<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>


|
|
The [[Electrocardiogram|ECG]] findings most commonly seen in myocarditis are:
The [[Electrocardiogram|ECG]] findings most commonly seen in [[myocarditis]] are:
*[[Sinus tachycardia]]
*[[Sinus tachycardia]]
*Diffuse [[T wave]] inversions
*Diffuse [[T wave]] inversions
*[[ST segment elevation]] without reciprocal depression
*[[ST segment elevation]] without reciprocal depression
*Low voltage of the [[QRS]] complexes
*Low voltage of the [[QRS]] complexes
*[[Arrhythmias]] such as atrial and ventricular ectopic beats, atrial and ventricular [[tachycardia]]s and [[atrial fibrillation]]
*[[Arrhythmias]] such as [[atrial]] and [[ventricular]] ectopic beats, [[atrial]] and [[Ventricular Tachycardia|ventricular tachycardias]] and [[atrial fibrillation]]
|-
|-
| colspan="2" style="background: #DCDCDC; " |[[Coronary heart disease|Coronary artery disease]]
| colspan="2" style="background: #DCDCDC; " |[[Coronary heart disease|Coronary artery disease]]
|
|
* Exercise tolerance test:
* Exercise tolerance test:
** ST segment changes considering duration and number of leads affected
** [[ST segment changes]] considering duration and number of leads affected
** Occurrence exercise induced [[ventricular arrhythmia]]
** Occurrence exercise induced [[ventricular arrhythmia]]
** Hemodynamic changes during test
** [[Hemodynamics|Hemodynamic]] changes during test
|}
|}


Revision as of 14:58, 26 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The most important and prevalent ECG findings associated with systemic lupus erythematosus (SLE) include sinus tachycardia, ST segment changes, and ventricular conduction disturbances.

Electrocardiogram

The most important and prevalent 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]

Important ECG findings in SLE patients based on prevalance:

Cardiac complication ECG findings
Cardiomegaly
Libman sacks endocarditis Heart failure[2]
  • P wave changes
  • R wave height changes
    • Primary increase
    • Decrease after progression
Myocardial infarction
Valvular involvement [3][4] Mitral valve stenosis
Mitral regurgitation
aArrythmias Ventricular arryhthmias
Supraventricular arrhythmias
Pericardial disease[5][6] Acute pericarditis
  • Typical lead involvement: I, II, aVL, aVF, and V3-V6
  • The ST segment depression:
    • Always in aVR
    • Frequently in V1
    • Occasionally in V2
  • J point in V6 > 25% of the height of the T wave apex
  • Reduce 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
Pericardial effusion
Myocarditis[7][8]

The ECG findings most commonly seen in myocarditis are:

Coronary artery disease

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. ↑ Troughton RW, Asher CR, Klein AL (2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.
  6. ↑ Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.
  7. ↑ Nakashima H, Honda Y, Katayama T (1994). "Serial electrocardiographic findings in acute myocarditis". Intern. Med. 33 (11): 659–66. PMID 7849377.
  8. ↑ Feldman AM, McNamara D (2000). "Myocarditis". N Engl J Med. 343 (19): 1388–98. doi:10.1056/NEJM200011093431908. PMID 11070105.

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