Myocarditis Overview
  • Myocardial inflammation in the absence of ischaemia.
  • Often associated with pericarditis , termed myopericarditis.
  • Usually a benign disease without serious long-term complications.
  • In the acute setting can cause arrhythmias, cardiac failure, cardiogenic shock and death.
  • May result in delayed dilated cardiomyopathy.
Causes of Myocarditis
  • Viral – including coxsackie B virus, HIV, influenza A, HSV, adenovirus.
  • Bacteria – including mycoplasma, rickettsia, leptospira.
  • Immune mediated – including sarcoidosis, scleroderma, SLE, Kawasaki’s disease.
  • Drugs / toxins – including clozapine, amphetamines.
ECG in Myocarditis

ECG changes can be variable and include:

  • Sinus tachycardia.
  • QRS / QT prolongation.
  • Diffuse T wave inversion.
  • Ventricular arrhythmias.
  • AV conduction defects.
  • With inflammation of the adjacent pericardium, ECG features of pericarditis can also been seen (= myopericarditis).

NB. The most common abnormality seen in myocarditis is sinus tachycardia with non-specific ST segment and T wave changes.

ECG Examples
Example 1
ECG Sinus Tachycardia
  • Sinus tachycardia with non-specific ST segment changes

Example 2
ECG myocarditis 2


  • Widespread concave ST elevation (pericarditic changes) in a child with viral myocarditis.

Advanced Reading



LITFL Further Reading




Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

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