Systemic lupus erythematosus electrocardiogram: Difference between revisions

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| rowspan="2" |Libman sachs endocarditis
| rowspan="2" |Libman sachs endocarditis
|[[Heart failure]]
|[[Heart failure]]
8331790
<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
* P wave changes
* R wave height changes
* R wave height changes
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|-
|-
| colspan="2" |[[Myocarditis]]
| colspan="2" |[[Myocarditis]]
7849377
<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>
<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>

Revision as of 18:08, 16 July 2017

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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
Myocardial infarction
  • Due to emboli
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)
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
Supraventricular arrhythmias
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 effusion
Myocarditis

[7]

[8]

The ECG findings most commonly seen in myocarditis are:

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

  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.
  2. Tsunakawa H, Miyamoto N, Kawabata M, Mashima S (1993). "[Electrocardiogram in heart failure]". Nippon Rinsho (in Japanese). 51 (5): 1222–32. PMID 8331790.
  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.
  4. TROUNCE JR (1952). "The electrocardiogram in mitral stenosis". Br Heart J. 14 (2): 185–92. PMC 479442. PMID 14916061.
  5. Troughton RW, Asher CR, Klein AL (2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.
  6. Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.
  7. Nakashima H, Honda Y, Katayama T (1994). "Serial electrocardiographic findings in acute myocarditis". Intern. Med. 33 (11): 659–66. PMID 7849377.
  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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