Myocarditis electrocardiogram
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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.
Overview
ECG pattern in patients with myocarditis simulate pericarditis and myocardial infarction. Arrhythmic waves and heart blocks may be noted in some patients.
Electrocardiogram
ECG findings in myocarditis are similar to those in pericarditis and myocardial infarction[1][2]. Myocarditis should be suspected in patients who are at low risk for MI and in those with normal coronaries on angiogram.
The ECG findings most commonly seen in myocarditis are[3]:
- 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 QRS may also be observed.
- Arrhythmias such as atrial and ventricular ectopics, tachycardias and fibrillations may also be present and is common in Chagas heart disease.
- Heart blocks are frequently observed in idiopathic giant cell myocarditis and cardiac sarcoidosis.
These EKG changes may persist for few months before they resolve spontaneously.
Prognostic Implications of EKG Changes
Despite its worrisome appearance, ST segment elevation suggestive of myocardial infarction is usually self-limited with no overt sequelae[4].
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[5].
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.
- ↑ 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.
- ↑ Feldman AM, McNamara D (2000). "Myocarditis". N Engl J Med. 343 (19): 1388–98. doi:10.1056/NEJM200011093431908. PMID 11070105.
- ↑ 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.
- ↑ 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.