ECG changes in Myocarditis

The most common ECG abnormalities seen in myocarditis are:

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
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 |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner


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