Systemic lupus erythematosus electrocardiogram: Difference between revisions

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| colspan="2" style="background: #DCDCDC; " |[[Cardiomegaly]]
| colspan="2" style="background: #DCDCDC; " |[[Cardiomegaly]]
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|
* ≥ [[QRS complex|QRS]] amplitude
* Increase in [[QRS complex|QRS]] amplitude
* Widened [[QRS]]/T angle
* Widened [[QRS]]/T angle
* [[Left Atrial Enlargement]] in V1
* [[Left Atrial Enlargement|Left atrial enlargement]]  
* [[Left axis deviation]]
* [[Left axis deviation]]
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* Due to [[emboli]]
* 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 elevation]] of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in V2–V3 and/or of 1 mm (0.1mV) in 2 contiguous chest leads or limb leads
**[[ST depression]] in at least two [[precordial leads]] V1-V4 (suggestive of [[posterior MI]])
**[[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]])
**[[ST depression]] in several leads plus [[ST elevation]] in lead aVR (suggestive of occlusion of the left main or proximal [[LAD artery]])
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* [[ECG]] findings suggestive of [[left atrial enlargement]] include:
* [[ECG]] findings suggestive of [[left atrial enlargement]] include:
**Broad, bifasic [[P wave]] in lead II ([[P mitrale]])
**Broad, biphasic [[P wave]] in lead II ([[P mitrale]])
**Enlargement of the terminal negative portion of the [[P wave]] in VI
**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]])
**[[P wave]] amplitude >2.5 mm in inferior leads (II, III, AVF) or >1.5 mm in V1/V2 ([[P pulmonale]])
|-
|-
| style="background: #DCDCDC; " |[[Mitral regurgitation]]
| style="background: #DCDCDC; " |[[Mitral regurgitation]]
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* [[ECG]] findings suggestive of [[left atrial enlargement]] include:
* [[ECG]] findings suggestive of [[left atrial enlargement]] include:
**Broad, bifasic [[P wave]] in lead II [[P mitrale|(P mitrale)]]
**Broad, biphasic [[P wave]] in lead II [[P mitrale|(P mitrale)]]
**Enlargement of the terminal negative portion of the [[P wave]] in V1
**Enlargement of the terminal negative portion of the [[P wave]] in V1
**[[P wave]] amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 (P pulmonale)
**[[P wave]] amplitude >2.5 mm in inferior leads (II, III, AVF) or >1.5 mm in V1/V2 (P pulmonale)
*[[ECG]] findings suggestive of [[left ventricular enlargement]] include:
*[[ECG]] findings suggestive of [[left ventricular enlargement]] include:
**Increased [[QRS]] voltage on [[ECG]]
**Increased [[QRS]] voltage on [[ECG]]
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**Inverted check mark pattern to the [[T wave]] in the lateral leads
**Inverted check mark pattern to the [[T wave]] in the lateral leads
|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Arrythmias|Arrythmias]]
| rowspan="2" style="background: #DCDCDC; " |[[Arrythmias|Arrhythmias]]
| style="background: #DCDCDC; " |[[Cardiac arrhythmia|Ventricular arryhthmias]]
| style="background: #DCDCDC; " |[[Cardiac arrhythmia|Ventricular arrhyhthmias]]
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|
* Incomplete [[bundle branch block]]
* Incomplete [[bundle branch block]]
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| style="background: #DCDCDC; " |[[Supraventricular arrhythmias]]
| style="background: #DCDCDC; " |[[Supraventricular arrhythmias]]
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* [[Premature atrial contraction|Premature atrial complexes]]
* [[Premature atrial contraction|Premature atrial complexes]] (PAC)
* [[Atrial fibrillation]]
* [[Atrial fibrillation]]
* [[Atrial flutter]]
* [[Atrial flutter]]
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| style="background: #DCDCDC; " |[[Acute pericarditis]]
| style="background: #DCDCDC; " |[[Acute pericarditis]]
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*Typical lead involvement: I, II, aVL, aVF, and V3-V6
*[[ST segment]] depression:
*The [[ST segment]] depression:
**Always in [[aVR]]
**Always in [[aVR]]
**Frequently in V1
**Frequently in V1
**Occasionally in V2
**Occasionally in V2
*[[J point]] in V6 > 25% of the height of the [[T waves|T wave apex]]  
*[[J point]] in V6 > 25% of the height of the [[T waves|T wave apex]]  
*Reduce voltage with quasi-specific ST-T waves due to increase in [[scar tissue]], fluid and [[fibrin]]
*Reduced voltage with quasi-specific ST-T waves due to increase in [[scar tissue]], fluid and [[fibrin]]
*The [[EKG]] abnormalities vary depending on the stage/severity of the [[pericarditis]]
*The [[EKG]] abnormalities vary depending on the stage/severity of the [[pericarditis]]
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*[[ST segment elevation]] without reciprocal depression
*[[ST segment elevation]] without reciprocal depression
*Low voltage of the [[QRS]] complexes
*Low voltage of the [[QRS]] complexes
*[[Arrhythmias]] such as [[atrial]] and [[ventricular]] ectopic beats, [[atrial]] and [[Ventricular Tachycardia|ventricular tachycardias]] and [[atrial fibrillation]]
*[[Arrhythmias]] such as [[atrial]] or [[ventricular]] ectopic beats, [[atrial]] or [[Ventricular Tachycardia|ventricular tachycardias]], and [[atrial fibrillation]]
|-
|-
| colspan="2" style="background: #DCDCDC; " |[[Coronary heart disease|Coronary artery disease]]
| colspan="2" style="background: #DCDCDC; " |[[Coronary heart disease|Coronary artery disease]]
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* Exercise tolerance test:
* Exercise tolerance test findings include:
** [[ST segment changes]] considering duration and number of leads affected
** [[ST segment changes]]
** Occurrence exercise induced [[ventricular arrhythmia]]
** Exercise induced [[ventricular arrhythmia]]
** [[Hemodynamics|Hemodynamic]] changes during test
** [[Hemodynamics|Hemodynamic]] changes during the test
|}
|}


Revision as of 14:06, 3 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The most common and important ECG findings associated with systemic lupus erythematosus (SLE) include sinus tachycardia, ST segment changes, and ventricular conduction disturbances. Other ECG findings are related to late complications of SLE and may range based on the complication.

Electrocardiogram

The most common and important ECG findings associated with systemic lupus erythematosus (SLE) include sinus tachycardia, ST segment changes, and ventricular conduction disturbances. SLE can affect cardiopulmonary system in different ways including pulmonary emboli development, Libman sacks endocarditis, and conduction problems. [1][2][3][4][5][6][7][8]

Important ECG findings in SLE patients based on cardiac complication:

Cardiac complication ECG findings
Cardiomegaly
Libman sacks endocarditis Heart failure
  • P wave changes
  • R wave height changes
    • Primary increase
    • Decrease after progression
Myocardial infarction
Valvular involvement Mitral valve stenosis
Mitral regurgitation
Arrhythmias Ventricular arrhyhthmias
Supraventricular arrhythmias
Pericardial disease Acute pericarditis
Pericardial effusion
Myocarditis

The ECG findings most commonly seen in myocarditis are:

Coronary artery disease

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. ↑ Nakashima H, Honda Y, Katayama T (1994). "Serial electrocardiographic findings in acute myocarditis". Intern. Med. 33 (11): 659–66. PMID 7849377.
  6. ↑ Feldman AM, McNamara D (2000). "Myocarditis". N Engl J Med. 343 (19): 1388–98. doi:10.1056/NEJM200011093431908. PMID 11070105.
  7. ↑ Troughton RW, Asher CR, Klein AL (2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.
  8. ↑ Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.

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