Endocarditis electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Maliha Shakil, M.D. [3]

Overview

On EKG, endocarditis may be characterized by conduction abnormalities, low QRS voltage, ST elevation, heart block, ventricular tachycardia, and supraventricular tachycardia.

Electrocardiogram

An ECG may be helpful in the diagnosis of endocarditis. Findings on an ECG diagnostic of endocarditis include:

• Increased PR interval

• Conduction abnormalities
• Atrioventricular dissociation which includes atrioventricular block with accelerated junctional escape
• Low QRS voltage, ST elevation
• Heart block which includes with first-degree heart block and complete heart block
• Ventricular tachycardia
• Supraventricular tachycardia

This is an electrocardiogram from a man in his 80's. The patient has severe lung disease, has mitral regurgitation secondary to bacterial endocarditis , and is taking digoxin, Lasix and potassium. The electrocardiogram shows sinus rhythm and a QRS with a left axis deviation, a QRS duration of 118 milliseconds and a tall R wave in the first precordial lead V1 with an R wave height of approximately 21 mm. The prolonged QRS duration and the S waves that are seen as lead 1 and lead 6 suggest a right on the branch block and a left axis deviation suggests a left anterior semi-block. Finally the tall R wave in V1 lead suggests right ventricular hypertrophy.

Electrocardiogram. Day 1 ECG on left and day 2 on right. Day 1 ECG reveals probable sinus tachycardia with first-degree heart block at 111 bpm. Day 2 ECG shows complete heart block with a ventricular rate of 67 bpm. Case courtesy by Shahzad Khan et al