Myocarditis electrocardiogram: Difference between revisions
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__NOTOC__ | |||
{{myocarditis}} | {{myocarditis}} | ||
{{CMG}} | {{CMG}} {{AE}} [[Varun Kumar]] M.B.B.S., {{Maliha}}{{Homa}} | ||
==Overview== | ==Overview== | ||
The presence of [[ST segment elevation]] in patients with [[myocarditis]] can mimic [[pericarditis]] and [[myocardial infarction]]. [[Arrhythmias]] and [[heart block]] may also be observed in myocarditis [[patients]]. Myocarditis can be distinguished from [[pericarditis]] by the presence of [[PR depression]] in the [[patient]] with [[pericarditis]]. | |||
==Electrocardiogram== | ==Electrocardiogram== | ||
The [[electrocardiogram|ECG]] findings most commonly seen in myocarditis are<ref name="pmid11070105">{{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>: | * The [[ECG]] findings in myocarditis are similar to those in [[pericarditis]] and [[myocardial infarction]]. Myocarditis should be suspected in [[Patient|patients]] who are at low risk for [[ischemic heart disease]] and [[MI]] and in those [[patients]] with normal [[coronary arteries]] on [[coronary angiography]].<ref name="pmid3354405">{{cite journal| author=Miklozek CL, Crumpacker CS, Royal HD, Come PC, Sullivan JL, Abelmann WH| title=Myocarditis presenting as acute myocardial infarction. | journal=Am Heart J | year= 1988 | volume= 115 | issue= 4 | pages= 768-76 | pmid=3354405 | doi= | pmc= | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3354405 }} </ref><ref name="pmid14645641">{{cite journal| author=Wang K, Asinger RW, Marriott HJ| title=ST-segment elevation in conditions other than acute myocardial infarction. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 22 | pages= 2128-35 | pmid=14645641 | doi=10.1056/NEJMra022580 | pmc= | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14645641 }} </ref> | ||
*[[Sinus tachycardia]] | * The [[electrocardiogram|ECG]] findings most commonly seen in myocarditis are:<ref name="pmid11070105">{{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>{{Cite journal | ||
*Diffuse [[T wave]] inversions | | author = [[T. Morgera]], [[A. Di Lenarda]], [[L. Dreas]], [[B. Pinamonti]], [[F. Humar]], [[R. Bussani]], [[F. Silvestri]], [[D. Chersevani]] & [[F. Camerini]] | ||
*[[ST segment]] | | title = Electrocardiography of myocarditis revisited: clinical and prognostic significance of electrocardiographic changes | ||
*Low voltage QRS may | | journal = [[American heart journal]] | ||
*[[Arrhythmias]] such as atrial and ventricular | | volume = 124 | ||
*Heart | | issue = 2 | ||
| pages = 455–467 | |||
| year = 1992 | |||
| month = August | |||
| doi = 10.1016/0002-8703(92)90613-z | |||
| pmid = 1636589 | |||
}}</ref><ref name="Cooper2009">{{cite journal|last1=Cooper|first1=Leslie T.|title=Myocarditis|journal=New England Journal of Medicine|volume=360|issue=15|year=2009|pages=1526–1538|issn=0028-4793|doi=10.1056/NEJMra0800028}}</ref><ref name="MorgeraDi Lenarda1992">{{cite journal|last1=Morgera|first1=Tullio|last2=Di Lenarda|first2=Andrea|last3=Dreas|first3=Lorella|last4=Pinamonti|first4=Bruno|last5=Humar|first5=Franco|last6=Bussani|first6=Rossana|last7=Silvestri|first7=Furio|last8=Chersevani|first8=Dorita|last9=Camerini|first9=Fulvio|title=Electrocardiography of myocarditis revisited: Clinical and prognostic significance of electrocardiographic changes|journal=American Heart Journal|volume=124|issue=2|year=1992|pages=455–467|issn=00028703|doi=10.1016/0002-8703(92)90613-Z}}</ref> | |||
**[[Sinus tachycardia]] | |||
**[[Diffuse]] [[T wave]] inversions | |||
**[[ST segment elevation]] without reciprocal depression. This helps in [[Differentiate|differentiating]] [[myocarditis]] from [[MI|infarction]] particularly when [[EKG]] changes are [[diffuse]]. | |||
**[[Low voltage QRS complexes|Low voltage of the QRS complexes]] may be observed. | |||
**[[Arrhythmias]] such as [[atrial]] and [[ventricular ectopic beats]], [[atrial]] and [[ventricular]] [[tachycardia]]s and [[atrial fibrillation]] may also be present and are common in [[Chagas]] [[heart disease]]. | |||
**[[Heart block]] is frequently observed in [[giant cell myocarditis]] and [[cardiac sarcoidosis]]. | |||
**These [[EKG]] changes may persist for several months before they resolve spontaneously. | |||
==Electrocardiographic Examples== | |||
* The [[EKG]] below shows [[diffuse]] [[ST segment elevation]] without reciprocal [[ST depression]] in a [[patient]] with myocarditis. | |||
[[Image:Peri022.jpg|center|500px]] | |||
---- | |||
[[Image: | * The [[EKG]] below shows [[diffuse]] [[T wave inversion]] in a [[patient]] with myocarditis. | ||
< | |||
[[Image:Chest pain and shortness of breath.jpg|center|500px]] | |||
---- | |||
* The [[EKG]] below shows [[diffuse]] [[ST elevation]] in a [[patient]] with myocarditis and [[pericarditis]]. | |||
[[Image:Myocar1.jpg||center|500px]] | |||
==Prognostic Implications of EKG Changes== | |||
*Despite its worrisome [[appearance]], [[ST segment elevation]] suggestive of [[myocardial infarction]] is usually self-limited with no overt [[sequelae]]. In contrast, the presence of either [[left bundle branch block]], [[q wave]]s suggestive of old [[infarct]] or high degree [[AV block]] are associated with a poor long term [[prognosis]] and are associated with the [[development]] of [[cardiac failure]] and [[cardiac transplantation]].<ref name="pmid10089938">{{cite journal| author=Nakashima H, Katayama T, Ishizaki M, Takeno M, Honda Y, Yano K| title=Q wave and non-Q wave myocarditis with special reference to clinical significance. | journal=Jpn Heart J | year= 1998 | volume= 39 | issue= 6 | pages= 763-74 | pmid=10089938 | doi= | pmc= | url= }} </ref><ref name="pmid1607543">{{cite journal| author=Dec GW, Waldman H, Southern J, Fallon JT, Hutter AM, Palacios I| title=Viral myocarditis mimicking acute myocardial infarction. | journal=J Am Coll Cardiol | year= 1992 | volume= 20 | issue= 1 | pages= 85-9 | pmid=1607543 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1607543 }} </ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WS}} | {{WS}} | ||
{{WH}} | {{WH}} | ||
[[Category:Medicine]] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up | [[Category:Up-To-Date]] | ||
[[Category: | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | |||
Latest revision as of 22:51, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Varun Kumar M.B.B.S., Maliha Shakil, M.D. [2] Homa Najafi, M.D.[3]
Overview
The presence of ST segment elevation in patients with myocarditis can mimic pericarditis and myocardial infarction. Arrhythmias and heart block may also be observed in myocarditis patients. Myocarditis can be distinguished from pericarditis by the presence of PR depression in the patient with pericarditis.
Electrocardiogram
- The ECG findings in myocarditis are similar to those in pericarditis and myocardial infarction. Myocarditis should be suspected in patients who are at low risk for ischemic heart disease and MI and in those patients with normal coronary arteries on coronary angiography.[1][2]
- The ECG findings most commonly seen in myocarditis are:[3][4][5][6]
- Sinus tachycardia
- Diffuse T wave inversions
- ST segment elevation without reciprocal depression. This helps in differentiating myocarditis from infarction particularly when EKG changes are diffuse.
- Low voltage of the QRS complexes may be observed.
- Arrhythmias such as atrial and ventricular ectopic beats, atrial and ventricular tachycardias and atrial fibrillation may also be present and are common in Chagas heart disease.
- Heart block is frequently observed in giant cell myocarditis and cardiac sarcoidosis.
- These EKG changes may persist for several months before they resolve spontaneously.
Electrocardiographic Examples
- The EKG below shows diffuse ST segment elevation without reciprocal ST depression in a patient with myocarditis.
- The EKG below shows diffuse T wave inversion in a patient with myocarditis.
- The EKG below shows diffuse ST elevation in a patient with myocarditis and pericarditis.
Prognostic Implications of EKG Changes
- Despite its worrisome appearance, ST segment elevation suggestive of myocardial infarction is usually self-limited with no overt sequelae. In contrast, the presence of either left bundle branch block, q waves suggestive of old infarct or high degree AV block are associated with a poor long term prognosis and are associated with the development of cardiac failure and cardiac transplantation.[7][8]
References
- ↑ Miklozek CL, Crumpacker CS, Royal HD, Come PC, Sullivan JL, Abelmann WH (1988). "Myocarditis presenting as acute myocardial infarction". Am Heart J. 115 (4): 768–76. PMID 3354405. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help) - ↑ Wang K, Asinger RW, Marriott HJ (2003). "ST-segment elevation in conditions other than acute myocardial infarction". N Engl J Med. 349 (22): 2128–35. doi:10.1056/NEJMra022580. PMID 14645641. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help) - ↑ Feldman AM, McNamara D (2000). "Myocarditis". N Engl J Med. 343 (19): 1388–98. doi:10.1056/NEJM200011093431908. PMID 11070105.
- ↑ T. Morgera, A. Di Lenarda, L. Dreas, B. Pinamonti, F. Humar, R. Bussani, F. Silvestri, D. Chersevani & F. Camerini (1992). "Electrocardiography of myocarditis revisited: clinical and prognostic significance of electrocardiographic changes". American heart journal. 124 (2): 455–467. doi:10.1016/0002-8703(92)90613-z. PMID 1636589. Unknown parameter
|month=ignored (help) - ↑ Cooper, Leslie T. (2009). "Myocarditis". New England Journal of Medicine. 360 (15): 1526–1538. doi:10.1056/NEJMra0800028. ISSN 0028-4793.
- ↑ Morgera, Tullio; Di Lenarda, Andrea; Dreas, Lorella; Pinamonti, Bruno; Humar, Franco; Bussani, Rossana; Silvestri, Furio; Chersevani, Dorita; Camerini, Fulvio (1992). "Electrocardiography of myocarditis revisited: Clinical and prognostic significance of electrocardiographic changes". American Heart Journal. 124 (2): 455–467. doi:10.1016/0002-8703(92)90613-Z. ISSN 0002-8703.
- ↑ Nakashima H, Katayama T, Ishizaki M, Takeno M, Honda Y, Yano K (1998). "Q wave and non-Q wave myocarditis with special reference to clinical significance". Jpn Heart J. 39 (6): 763–74. PMID 10089938.
- ↑ Dec GW, Waldman H, Southern J, Fallon JT, Hutter AM, Palacios I (1992). "Viral myocarditis mimicking acute myocardial infarction". J Am Coll Cardiol. 20 (1): 85–9. PMID 1607543.