Systemic lupus erythematosus electrocardiogram

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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
Cardiac involvement Cardiomegaly
  • ≥ QRS amplitude
  • Widened QRS/T angle
  • 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 Heart failure

8331790

  • P wave changes
  • R wave height changes
    • Primary increase
    • Decrease after progression
Myocardial infarction
  • Due to emboli
Valvular disease
Nonbacterial thrombotic endocarditis
Pericardial disease
Myocarditis
Coronary artery disease
  • 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

  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.

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