Myocarditis

ECG changes in Myocarditis

Other ECG changes are variable, and may include:

• Prolonged 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)

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, coronavirus (COVID19)
• Bacteria – including mycoplasma, rickettsia, leptospira
• Immune mediated – including sarcoidosis, scleroderma, SLE, Kawasaki’s disease
• Drugs / toxins – including clozapine, amphetamines

ECG Examples

Example 1

• Sinus tachycardia with non-specific ST segment changes

Example 2

Myopericarditis:

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

Related Topics

• Pericarditis

Advanced Reading

Online

• Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course. Understand ECG basics. Medmastery
• Wiesbauer F, Kühn P. ECG Mastery: Blue Belt online course: Become an ECG expert. Medmastery
• Kühn P, Houghton A. ECG Mastery: Black Belt Workshop. Advanced ECG interpretation. Medmastery
• Rawshani A. Clinical ECG Interpretation ECG Waves
• Smith SW. Dr Smith’s ECG blog.
• Wiesbauer F. Little Black Book of ECG Secrets. Medmastery PDF

Textbooks

• Zimmerman FH. ECG Core Curriculum. 2023
• Mattu A, Berberian J, Brady WJ. Emergency ECGs: Case-Based Review and Interpretations, 2022
• Straus DG, Schocken DD. Marriott’s Practical Electrocardiography 13e, 2021
• Brady WJ, Lipinski MJ et al. Electrocardiogram in Clinical Medicine. 1e, 2020
• Mattu A, Tabas JA, Brady WJ. Electrocardiography in Emergency, Acute, and Critical Care. 2e, 2019
• Hampton J, Adlam D. The ECG Made Practical 7e, 2019
• Kühn P, Lang C, Wiesbauer F. ECG Mastery: The Simplest Way to Learn the ECG. 2015
• Grauer K. ECG Pocket Brain (Expanded) 6e, 2014
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008
• Chan TC. ECG in Emergency Medicine and Acute Care 1e, 2004

LITFL Further Reading

• ECG Library Basics – Waves, Intervals, Segments and Clinical Interpretation
• ECG A to Z by diagnosis – ECG interpretation in clinical context
• ECG Exigency and Cardiovascular Curveball – ECG Clinical Cases
• 100 ECG Quiz – Self-assessment tool for examination practice
• ECG Reference SITES and BOOKS – the best of the rest