Myocarditis electrocardiogram: Difference between revisions
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==Electrocardiogram== | ==Electrocardiogram== | ||
ECG findings in myocarditis are similar to those in [[pericarditis]] and [[myocardial infarction]]<ref name="pmid3354405">{{cite journal| author=Miklozek CL, Crumpacker CS, Royal HD, Come PC, Sullivan JL, Abelmann WH| title=Myocarditis presenting as acute myocardial infarction. | journal=Am Heart J | year= 1988 | volume= 115 | issue= 4 | pages= 768-76 | pmid=3354405 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3354405 }} </ref><ref name="pmid14645641">{{cite journal| author=Wang K, Asinger RW, Marriott HJ| title=ST-segment elevation in conditions other than acute myocardial infarction. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 22 | pages= 2128-35 | pmid=14645641 | doi=10.1056/NEJMra022580 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14645641 }} </ref>. Myocarditis should be suspected in patients who are at low risk for [[ischemic heart disease]] and [[MI]] and in those patients with normal coronary arteries on [[coronary angiography]]. | The ECG findings in myocarditis are similar to those in [[pericarditis]] and [[myocardial infarction]]<ref name="pmid3354405">{{cite journal| author=Miklozek CL, Crumpacker CS, Royal HD, Come PC, Sullivan JL, Abelmann WH| title=Myocarditis presenting as acute myocardial infarction. | journal=Am Heart J | year= 1988 | volume= 115 | issue= 4 | pages= 768-76 | pmid=3354405 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3354405 }} </ref><ref name="pmid14645641">{{cite journal| author=Wang K, Asinger RW, Marriott HJ| title=ST-segment elevation in conditions other than acute myocardial infarction. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 22 | pages= 2128-35 | pmid=14645641 | doi=10.1056/NEJMra022580 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14645641 }} </ref>. Myocarditis should be suspected in patients who are at low risk for [[ischemic heart disease]] and [[MI]] and in those patients with normal coronary arteries on [[coronary angiography]]. | ||
The [[electrocardiogram|ECG]] findings most commonly seen in myocarditis are<ref name="pmid11070105">{{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<ref name="pmid11070105">{{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>: | ||
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*Diffuse [[T wave]] inversions | *Diffuse [[T wave]] inversions | ||
*[[ST segment]] elevation without reciprocal depression. This helps in differentiating [[myocarditis]] from [[MI|infarction]] particularly when EKG changes are diffuse. | *[[ST segment]] elevation without reciprocal depression. This helps in differentiating [[myocarditis]] from [[MI|infarction]] particularly when EKG changes are diffuse. | ||
*Low voltage QRS may | *Low voltage of the [[QRS]] complexes may be observed. | ||
*[[Arrhythmias]] such as atrial and ventricular ectopics, [[tachycardia]]s and [[Atrial fibrillation|fibrillation]]s may also be present and | *[[Arrhythmias]] such as atrial and ventricular ectopics, [[tachycardia]]s and [[Atrial fibrillation|fibrillation]]s may also be present and are common in [[Chagas]] heart disease. | ||
*Heart | *Heart block is frequently observed in [[giant cell myocarditis]] and cardiac [[sarcoidosis]]. | ||
These EKG changes may persist for | These EKG changes may persist for several months before they resolve spontaneously. | ||
[[Image:Peri022.jpg|thumb|left|400px|[[ST segment elevation]]s without reciprocal depression in myocarditis]] | [[Image:Peri022.jpg|thumb|left|400px|[[ST segment elevation]]s without reciprocal depression in myocarditis]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.
Overview
ECG pattern in patients with myocarditis simulate pericarditis and myocardial infarction. Arrhythmic waves and heart blocks may be noted in some patients.
Electrocardiogram
The ECG findings in myocarditis are similar to those in pericarditis and myocardial infarction[1][2]. Myocarditis should be suspected in patients who are at low risk for ischemic heart disease and MI and in those patients with normal coronary arteries on coronary angiography.
The ECG findings most commonly seen in myocarditis are[3]:
- Sinus tachycardia
- Diffuse T wave inversions
- ST segment elevation without reciprocal depression. This helps in differentiating myocarditis from infarction particularly when EKG changes are diffuse.
- Low voltage of the QRS complexes may be observed.
- Arrhythmias such as atrial and ventricular ectopics, tachycardias and fibrillations may also be present and are common in Chagas heart disease.
- Heart block is frequently observed in giant cell myocarditis and cardiac sarcoidosis.
These EKG changes may persist for several months before they resolve spontaneously.
Prognostic Implications of EKG Changes
Despite its worrisome appearance, ST segment elevation suggestive of myocardial infarction is usually self-limited with no overt sequelae[4].
In contrast, the presence of either left bundle branch block, q waves suggestive of old infarct or high degree AV block are associated with a poor long term prognosis and are associated with the development of cardiac failure and cardiac transplantation[5].
References
- ↑ Miklozek CL, Crumpacker CS, Royal HD, Come PC, Sullivan JL, Abelmann WH (1988). "Myocarditis presenting as acute myocardial infarction". Am Heart J. 115 (4): 768–76. PMID 3354405.
- ↑ Wang K, Asinger RW, Marriott HJ (2003). "ST-segment elevation in conditions other than acute myocardial infarction". N Engl J Med. 349 (22): 2128–35. doi:10.1056/NEJMra022580. PMID 14645641.
- ↑ Feldman AM, McNamara D (2000). "Myocarditis". N Engl J Med. 343 (19): 1388–98. doi:10.1056/NEJM200011093431908. PMID 11070105.
- ↑ Dec GW, Waldman H, Southern J, Fallon JT, Hutter AM, Palacios I (1992). "Viral myocarditis mimicking acute myocardial infarction". J Am Coll Cardiol. 20 (1): 85–9. PMID 1607543.
- ↑ Nakashima H, Katayama T, Ishizaki M, Takeno M, Honda Y, Yano K (1998). "Q wave and non-Q wave myocarditis with special reference to clinical significance". Jpn Heart J. 39 (6): 763–74. PMID 10089938.