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  There is no electrocardiographic sign specific to myocarditis.

  Generally pericarditis accompanies the myocarditis.

  A normal ECG does not exclude the diagnosis of myocarditis.




ECG abnormalities that may be observed in patients with myocarditis / myopericarditis

  Sinus tachycardia

  Diffuse T wave inversion

  Atrioventricular (AV) blocks

  QT interval prolongation

  Bundle branch blocks

  Ventricular arrhythmias

  Abnormal (pathological) Q waves

  ST segment elevation mimicking acute myocardial infarction (rare)

  Sick sinus syndrome (rare)




ECG and prognosis in myocarditis

  A gradual increase in the width of QRS complex is suggested as a sign of exacerbation of myocarditis.

  Prolonged QRS duration is suggested as an independent predictor for cardiac death or

      heart transplantation in patients with suspected myocarditis.




References

  Anadolu Kardiyol Derg 2012;12:279-280 .

  Tex Heart Inst J 2011;38:288-290.

  Circ J 2011;75:932-938.

  Can J Cardiol 2011;27:870.e1-3. Epub 2011 Oct 15

  Cardiol J 2011;18:552-555.

  Circ J 2011;75:734-743.

  Eur J Heart Fail 2011;13:398-405.

  Int J Cardiol 2011 Aug 31. [Epub ahead of print]. DOI: http://dx.doi.org/10.1016/j.ijcard.2011.07.090

  Am Heart Journal 1994;127:1290.





ECG 1. The ECG above belongs to a 34 years-old woman who was diagnosed as having diphtheria myocarditis.
ST segment is elevated in leads III, aVR, and V1 while it is depressed in other leads. A VPC is also seen.
Complete AV block developes after the VPC and nodal rhythm with P waves unrelated to the QRS complexes
(the last two beats) ensues.

Click here for a more detailed ECG

The ECG above has been used with the permission of Anatolian Journal of Cardiology and AVES Publishing.

Click here to read the relevant article of Dr. Ornek et al.





ECG 2. The ECG above belongs to a 20 years-old man who had developed myopericarditis after inhalation of the butane gas.
Widespread ST segment elevation is seen.
His cardiac Troponin I level increased up to 3.5 ng/mL. Coronary angiography revealed normal coronary arteries.

Click here for a more detailed ECG

The ECG above has been used with the permission of Anatolian Journal of Cardiology and AVES Publishing.

Click here to read the relevant article of Dr. Bayar et al.





ECG 3a. The ECG above is from a 17 years-old boy with varicella infection, severe chest pain and elevated cardiac enzymes.
The ST segment elevation in leads I, aVL, V4 to V6 suggests acute myocardial infarction at first glance.
His coronary angiography showed normal coronary arteries and varicella myopericarditis was diagnosed.

The ECG above has been used with the permission of
Texas Heart Institute Journal.

Click here for a more detailed ECG

Click here to go to the relevant article of the Texas Heart Institute Journal




ECG 3b. His ECG at 5th day of hospitalization (before discharge) is seen above.
ST segments are nearly normal.

The ECG above has been used with the permission of
Texas Heart Institute Journal.

Click here for a more detailed ECG

Click here to go to the relevant article of the Texas Heart Institute Journal




ECG 3c. Above is his ECG after 2 weeks. Negative T waves are seen in leads V3 to V6.

The ECG above has been used with the permission of
Texas Heart Institute Journal.

Click here for a more detailed ECG

Click here to go to the relevant article of the Texas Heart Institute Journal