Systemic lupus erythematosus electrocardiogram: Difference between revisions

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Revision as of 18:13, 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^[2]	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 ^[3]^[4]	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 ^[3]^[4]	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^[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 Yhe EKG abnormalities vary depending on the stage/severity of the pericarditis
Pericardial disease^[5]^[6]	Pericardial effusion	Electrical alternans An electrocardiographic phenomenon of alternation of QRS complex amplitude or axis between beats
Myocarditis^[7]^[8]		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.
↑ Tsunakawa H, Miyamoto N, Kawabata M, Mashima S (1993). "[Electrocardiogram in heart failure]". Nippon Rinsho (in Japanese). 51 (5): 1222–32. PMID 8331790.
↑ 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.
↑ Nakashima H, Honda Y, Katayama T (1994). "Serial electrocardiographic findings in acute myocarditis". Intern. Med. 33 (11): 659–66. PMID 7849377.
↑ 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.

[pmid8331790-2] Tsunakawa H, Miyamoto N, Kawabata M, Mashima S (1993). "[Electrocardiogram in heart failure]". Nippon Rinsho (in Japanese). 51 (5): 1222–32. PMID 8331790.

[pmid20435842-3] 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.

[pmid14916061-4] TROUNCE JR (1952). "The electrocardiogram in mitral stenosis". Br Heart J. 14 (2): 185–92. PMC 479442. PMID 14916061.

[troughton-5] Troughton RW, Asher CR, Klein AL (2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.

[spodick-6] Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.

[pmid7849377-7] Nakashima H, Honda Y, Katayama T (1994). "Serial electrocardiographic findings in acute myocarditis". Intern. Med. 33 (11): 659–66. PMID 7849377.

[pmid110701052-8] Feldman AM, McNamara D (2000). "Myocarditis". N Engl J Med. 343 (19): 1388–98. doi:10.1056/NEJM200011093431908. PMID 11070105.

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@@ Line 11: / Line 11: @@
 === Important ECG findings in SLE patients based on prevalance: ===
 {| class="wikitable"
-| colspan="2" |Cardiac complication
+| colspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Cardiac complication
-|ECG findings
+| align="center" style="background: #4479BA; color: #FFFFFF; " |ECG findings
 |-
-| colspan="2" |[[Cardiomegaly]]
+| colspan="2" style="background: #DCDCDC; " |[[Cardiomegaly]]
 |
 * ≥ QRS amplitude
@@ Line 21: / Line 21: @@
 * Left axis deviation
 |-
-| rowspan="2" |Libman sachs endocarditis
+| rowspan="2" style="background: #DCDCDC; " |Libman sachs endocarditis
-|[[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
@@ Line 29: / Line 29: @@
 ** Decrease after progression
 |-
-|[[Myocardial infarction]]
+| style="background: #DCDCDC; " |[[Myocardial infarction]]
 |
 * Due to emboli
@@ Line 37: / Line 37: @@
 **New [[left bundle branch block]] ([[LBBB]])
 |-
-| 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>
+| 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>
-|[[Mitral stenosis|Mitral valve stenosis]]
+| style="background: #DCDCDC; " |[[Mitral stenosis|Mitral valve stenosis]]
 |
 * ECG findings suggestive of [[left atrial enlargement]] include:
@@ Line 45: / Line 45: @@
 **P wave amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 (P pulmonale)
 |-
-|[[Mitral regurgitation]]
+| style="background: #DCDCDC; " |[[Mitral regurgitation]]
 |
 * ECG findings suggestive of [[left atrial enlargement]] include:
@@ Line 56: / Line 56: @@
 **Inverted check mark pattern to the T wave in the lateral leads
 |-
-| rowspan="2" |[[Arrythmias|aArrythmias]]
+| rowspan="2" style="background: #DCDCDC; " |[[Arrythmias|aArrythmias]]
-|[[Cardiac arrhythmia|Ventricular arryhthmias]]
+| style="background: #DCDCDC; " |[[Cardiac arrhythmia|Ventricular arryhthmias]]
 |
 * Incomplete bundle branch block
@@ Line 65: / Line 65: @@
 * [[Left posterior fascicular block]]
 |-
-|[[Supraventricular arrhythmias]]
+| style="background: #DCDCDC; " |[[Supraventricular arrhythmias]]
 |
 * [[Premature atrial contraction|Premature atrial complexes]]
@@ Line 71: / Line 71: @@
 * [[Atrial flutter]]
 |-
-| 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>
+| rowspan="2" style="background: #DCDCDC; " |[[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]]
+| style="background: #DCDCDC; " |[[Acute pericarditis]]
 |
 *Typical lead involvement: I, II, aVL, aVF, and V3-V6
@@ Line 83: / Line 83: @@
 *Yhe [[EKG]] abnormalities vary depending on the stage/severity of the [[pericarditis]]
 |-
-|[[Pericardial effusion]]
+| style="background: #DCDCDC; " |[[Pericardial effusion]]
 |
 * [[Electrical alternans]]
 ** An [[Electrocardiogram|electrocardiographic]] phenomenon of alternation of [[QRS complex]] amplitude or axis between beats
 |-
-| colspan="2" |[[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>
 |
@@ Line 98: / Line 98: @@
 *[[Arrhythmias]] such as atrial and ventricular ectopic beats, atrial and ventricular [[tachycardia]]s and [[atrial fibrillation]]
 |-
-| colspan="2" |[[Coronary heart disease|Coronary artery disease]]
+| colspan="2" style="background: #DCDCDC; " |[[Coronary heart disease|Coronary artery disease]]
 |
 * Exercise tolerance test: