Systemic lupus erythematosus electrocardiogram

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

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.

Important ECG findings in SLE patients based on cardiac complication:

Cardiac complication		ECG findings
Cardiomegaly		Increase in QRS amplitude Widened QRS/T angle Left atrial enlargement Left axis deviation
Libman sacks endocarditis	Heart failure	P wave changes R wave height changes Primary increase Decrease after progression
	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)
Valvular involvement	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)
	Mitral regurgitation	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 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
Arrhythmias	AV Blocks	Incomplete bundle branch block Right bundle branch block Left bundle branch block Left anterior fascicular block Left posterior fascicular block
	Supraventricular arrhythmias	Premature atrial complexes (PAC) Atrial fibrillation Atrial flutter
Pericardial disease	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 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
	Pericardial effusion	Electrical alternans An electrocardiographic phenomenon of alternation of QRS complex amplitude or axis between beats
Myocarditis		The 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 tachycardias, and atrial fibrillation
Coronary artery disease		Exercise tolerance test findings include: ST segment changes Exercise induced ventricular arrhythmia Hemodynamic changes during the test