Systemic lupus erythematosus electrocardiogram: Difference between revisions

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Revision as of 18:06, 16 July 2017

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 cardiaopulmonary 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		≥ QRS amplitude Widened QRS/T angle Left Atrial Enlargement in V1 Left axis deviation
Libman sachs endocarditis	Heart failure 8331790	P wave changes R wave height changes Primary increase Decrease after progression
Libman sachs endocarditis	Myocardial infarction	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 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 ^[2]^[3]	Mitral valve stenosis	ECG findings suggestive of left atrial enlargement include: Broad, bifid P wave in lead II (P mitrale) 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)
Valvular involvement ^[2]^[3]	Mitral regurgitation	ECG findings suggestive of left atrial enlargement include: Broad, bifid P wave in lead II (P mitrale) 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) 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
aArrythmias	Ventricular arryhthmias	Incomplete bundle branch block Right bundle branch block Left bundle branch block Left anterior fascicular block Left posterior fascicular block
aArrythmias	Supraventricular arrhythmias	Premature atrial complexes Atrial fibrillation Atrial flutter
Pericardial disease ^[4]^[5]	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 Yhe EKG abnormalities vary depending on the stage/severity of the pericarditis
Pericardial disease ^[4]^[5]	Pericardial effusion	Electrical alternans An electrocardiographic phenomenon of alternation of QRS complex amplitude or axis between beats
Myocarditis 7849377 ^[6]		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 and ventricular ectopic beats, atrial and ventricular tachycardias and atrial fibrillation
Coronary artery disease		Exercise tolerance test: ST segment changes considering duration and number of leads affected Occurrence exercise induced ventricular arrhythmia Hemodynamic changes during test

References

↑ 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.
↑ 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.
↑ TROUNCE JR (1952). "The electrocardiogram in mitral stenosis". Br Heart J. 14 (2): 185–92. PMC 479442. PMID 14916061.
↑ Troughton RW, Asher CR, Klein AL (2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.
↑ Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.
↑ Feldman AM, McNamara D (2000). "Myocarditis". N Engl J Med. 343 (19): 1388–98. doi:10.1056/NEJM200011093431908. PMID 11070105.

Template:WH Template:WS

[pmid24838943-1] 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.

[pmid20435842-2] 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.

[pmid14916061-3] TROUNCE JR (1952). "The electrocardiogram in mitral stenosis". Br Heart J. 14 (2): 185–92. PMC 479442. PMID 14916061.

[troughton-4] Troughton RW, Asher CR, Klein AL (2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.

[spodick-5] Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.

[pmid110701052-6] Feldman AM, McNamara D (2000). "Myocarditis". N Engl J Med. 343 (19): 1388–98. doi:10.1056/NEJM200011093431908. PMID 11070105.

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@@ Line 11: / Line 11: @@
 === Important ECG findings in SLE patients based on prevalance: ===
 {| class="wikitable"
-|
+| colspan="2" |Cardiac complication
-|Cardiac complication
-|
 |ECG findings
 |-
-| rowspan="9" |Cardiac involvement
+| colspan="2" |[[Cardiomegaly]]
-|[[Cardiomegaly]]
-|
 |
 * ≥ QRS amplitude
@@ Line 24: / Line 20: @@
 * Left Atrial Enlargement in V1
 * Left axis deviation
-*
-|-
-|Myocarditis 7849377
-|
-|
-* ST elevation without reciprocal ST depression
-* Decrease QRS amplitudes
-* Abnormal Q waves
 |-
-|Libman sachs endocarditis
+| rowspan="2" |Libman sachs endocarditis
-|Heart failure
+|[[Heart failure]]
 8331790
 |
@@ Line 42: / Line 30: @@
 ** Decrease after progression
 |-
-|
+|[[Myocardial infarction]]
-|Myocardial infarction
 |
 * 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 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 disease]]
+| rowspan="2" |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>
+|[[Mitral stenosis|Mitral valve stenosis]]
 |
+* ECG findings suggestive of [[left atrial enlargement]] include:
+**Broad, bifid [[P wave]] in lead II (P mitrale)
+**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)
+|-
+|[[Mitral regurgitation]]
 |
+* ECG findings suggestive of [[left atrial enlargement]] include:
+**Broad, bifid [[P wave]] in lead II (P mitrale)
+**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)
+*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
 |-
-|[[Nonbacterial thrombotic endocarditis]]
+| rowspan="2" |[[Arrythmias|aArrythmias]]
+|[[Cardiac arrhythmia|Ventricular arryhthmias]]
 |
+* Incomplete bundle branch block
+* [[Right bundle branch block]]
+* [[Left bundle branch block]]
+* [[Left anterior fascicular block]]
+* [[Left posterior fascicular block]]
+|-
+|[[Supraventricular arrhythmias]]
 |
+* [[Premature atrial contraction|Premature atrial complexes]]
+* [[Atrial fibrillation]]
+* [[Atrial flutter]]
 |-
-|[[Pericardial disease]]
+| rowspan="2" |[[Pericardial disease]] <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>
+|[[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]]
+*Yhe [[EKG]] abnormalities vary depending on the stage/severity of the [[pericarditis]]
+|-
+|[[Pericardial effusion]]
 |
+* [[Electrical alternans]]
+** An [[Electrocardiogram|electrocardiographic]] phenomenon of alternation of [[QRS complex]] amplitude or axis between beats
 |-
-|[[Myocarditis]]
+| colspan="2" |[[Myocarditis]]
-|
+7849377
+<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:
+*[[Sinus tachycardia]]
+*Diffuse [[T wave]] inversions
+*[[ST segment elevation]] without reciprocal depression
+*Low voltage of the [[QRS]] complexes
+*[[Arrhythmias]] such as atrial and ventricular ectopic beats, atrial and ventricular [[tachycardia]]s and [[atrial fibrillation]]
 |-
-|[[Coronary heart disease|Coronary artery disease]]
+| colspan="2" |[[Coronary heart disease|Coronary artery disease]]
-|
 |
+* Exercise tolerance test:
+** ST segment changes considering duration and number of leads affected
+** Occurrence exercise induced [[ventricular arrhythmia]]
+** Hemodynamic changes during test
 |}
-* Sinus tachycardia
-* Prolong QT
-* ST segment changes
-** Nonspecific
-** Compatible with myocardial infarction
-* Left ventricular hypertrophy
-* Ventricular conduction disturbances
-** 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
-** Atrial fibrillation
-** Atrial flutter
-* Premature ventricular contractions
-* Atrioventricular heart block
-* Right ventricular hypertrophy
-* Right ventricular strain pattern
-** T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF). This pattern is associated with high pulmonary artery pressures.
-* Right axis deviation
-* Dominant R wave in V1
-** Shows the manifestation of acute right ventricular dilatation.
-* Right atrial enlargement (P pulmonale)
 ==References==