Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review
Carmelo Buttà1, Luca Zappia1, Giulia Laterra1
1Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Insights
Electrocardiogram (ECG) abnormalities in acute myocarditis, though non-specific, are crucial for diagnosis and prognosis. Key findings include sinus tachycardia, ST/T-wave changes, and specific patterns differentiating it from myocardial infarction, guiding patient management.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrophysiology
Background:
- Acute myocarditis diagnosis is challenging due to non-specific clinical presentations.
- Electrocardiogram (ECG) is a primary screening tool for myocarditis, despite displaying varied abnormalities.
Purpose of the Study:
- To comprehensively evaluate ECG alterations in acute myocarditis.
- To assess the prevalence, pathophysiology, diagnostic role, and prognostic value of ECG findings.
Main Methods:
- Systematic review of ECG alterations in acute myocarditis.
- Analysis of ECG findings in relation to clinical presentation, differential diagnosis, and patient outcomes.
Main Results:
- Sinus tachycardia and nonspecific ST/T-wave changes are most common ECG findings.
- PR segment depression and ST elevation with pericarditis patterns suggest perimyocarditis over myocardial infarction.
- Poorer prognosis is linked to pathological Q waves, wide QRS, prolonged QT, AV block, and ventricular tachyarrhythmia; early repolarization patterns indicate a better prognosis.
Conclusions:
- ECG alterations in acute myocarditis provide valuable insights for clinical practice.
- ECG findings aid in tailoring patient therapy, hospitalization duration, and follow-up frequency.
Background:
Acute myocarditis represents a challenging diagnosis as there is no pathognomonic clinical presentation. In patients with myocarditis, electrocardiogram (ECG) can display a variety of non-specific abnormalities. Nevertheless, ECG is widely used as an initial screening tool for myocarditis.
Methods:
We researched all possible ECG alterations during acute myocarditis evaluating prevalence, physiopathology, correlation with clinical presentation patterns, role in differential diagnosis, and prognostic yield.
Results:
The most common ECG abnormality in myocarditis is sinus tachycardia associated with nonspecific ST/T-wave changes. The presence of PR segment depression both in precordial and limb leads, a PR segment depression in leads with ST segment elevation, a PR segment elevation in aVR lead or a ST elevation with pericarditis pattern favor generally diagnosis of perimyocarditis rather than myocardial infarction. In patients with acute myocarditis, features associated with a poorer prognosis are: pathological Q wave, wide QRS complex, QRS/T angle ≥ 100°, prolonged QT interval, high-degree atrioventricular block and malignant ventricular tachyarrhythmia. On the contrary, ST elevation with a typical early repolarization pattern is associated with a better prognosis.
Conclusions:
ECG alterations in acute myocarditis could be very useful in clinical practice for a patient-tailored approach in order to decide appropriate therapy, length of hospitalization, and frequency of followup.
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