Systemic lupus erythematosus electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Mahshid Mir, M.D. [2]

## Overview

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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

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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:

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Cardiac complication  | ECG findings  | ECG examples

|
|

Cardiomegaly |

* Increase in QRS amplitude
* Widened QRS/T angle
* Left atrial enlargement
* Left axis deviation

| http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Libman sacks endocarditis | Heart failure |

* P wave changes
* R wave height changes
* Primary increase
* Decrease after progression

| http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Myocardial infarction |

* Due to emboli
* 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 several leads plus ST elevation in lead aVR (suggestive of occlusion of the left main or proximal LAD artery)
* New left bundle branch block (LBBB)

| http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Valvular involvement | Mitral valve stenosis |

* ECG findings suggestive of left atrial enlargement include:
* Broad and biphasic P wave in lead II (P mitrale)
* Enlargement of the terminal negative portion of the P wave in VI
* P wave amplitude >2.5 mm in inferior leads (II, III, AVF) or >1.5 mm in V1/V2 (P pulmonale)

| http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Mitral regurgitation |

* ECG findings suggestive of left atrial enlargement include:
* Broad and biphasic P wave in lead II (P mitrale)
* Enlargement of the terminal negative portion of the P wave in V1
* 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:
* Increased QRS voltage on ECG
* Strain pattern
* Inverted check mark pattern to the T wave in the lateral leads

| http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Arrhythmias | AV Blocks |

* Incomplete bundle branch block
* Right bundle branch block
* Left bundle branch block
* Left anterior fascicular block
* Left posterior fascicular block

| http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Supraventricular arrhythmias |

* Premature atrial complexes (PAC)
* Atrial fibrillation
* Atrial flutter

| http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Pericardial disease | Acute pericarditis |

* 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
* 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

| http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu
Pericardial effusion |

* Electrical alternans
* An electrocardiographic phenomenon of alternation of QRS complex amplitude or axis between beats

| https://en.wikipedia.org/wiki/Pericardial_effusion Courtesy dedicated to wikipedia
Myocarditis |

The ECG findings most commonly seen in myocarditis are:

* Sinus tachycardia
* Diffuse T wave inversions
* ST segment elevation without reciprocal depression
* Low voltage of the QRS complexes
* Arrhythmias such as atrial or ventricular ectopic beats, atrial or ventricular tachycardias, and atrial fibrillation

| https://en.wikipedia.org/wiki/Myocarditis Courtesy dedicated to wikipedia
Coronary artery disease |

* Exercise tolerance test findings include:
* ST segment changes
* Exercise induced ventricular arrhythmia
* Hemodynamic changes during the test

| http://ecg.utah.edu/img_index Courtesy dedicated to ecg.utah.edu

## References

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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.CS1 maint: Unrecognized language (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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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