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Electrocardiographic findings in patients with connective tissue disease
Insights
Heart issues are common in connective tissue diseases, showing up as abnormal ECG patterns, even in rare cases like dermatomyositis. Steroid treatment may increase ST segment changes in these patients.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Connective tissue diseases (CTDs) encompass a range of autoimmune disorders.
- Cardiac involvement is a known complication in many CTDs, but its prevalence and specific electrocardiographic (ECG) manifestations across various CTDs require further elucidation.
Purpose of the Study:
- To compare ECG findings in patients with rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, dermatomyositis, scleroderma, and polyarteritis nodosa against a control group.
- To identify specific ECG abnormalities associated with each CTD and the potential impact of steroid treatment on cardiac findings.
Main Methods:
- Electrocardiograms (ECGs) from 257 patients (across six CTDs) and 106 controls were analyzed.
- ECG findings were classified using the Minnesota Code.
- Patient groups were compared with controls, and steroid-treated patients were compared with non-steroid-treated patients.
Main Results:
- Pathological Q-QS, ST segment, and T wave patterns were more frequent in all CTD patient groups compared to controls, including dermatomyositis.
- Higher P terminal force (PTF) was observed in the patient group.
- Conduction defects appeared more common in CTDs, while differences in ectopic beats, arrhythmias, QRS duration/axis, and R wave amplitude were not significant. ST changes were more frequent in steroid-treated patients.
Conclusions:
- Cardiac involvement is prevalent across various connective tissue diseases, manifesting through diverse ECG changes.
- ECG abnormalities in CTD patients can mimic those seen in coronary heart disease, highlighting the need for careful cardiac evaluation.
- Steroid therapy may be associated with an increased frequency of specific ECG changes, particularly ST segment abnormalities.
Abstract:
ECG changes in 49 patients with rheumatoid arthritis, 18 with ankylosing spondylitis, 47 with systemic lupus erythematosus, 17 with dermatomyositis, 21 with scleroderma and 7 with polyarteritis nodosa were compared with ECG changes in 106 control subjects. The classification of ECG findings was based mainly on the Minnesota Code. Compared with control subjects, pathological Q--QS, ST segment and T wave patterns were more common in all patient groups--including dermatomyositis, in which cardiac involvement has rarely been reported. P terminal force (PTF) was higher in the patient group. Conduction defects were probably more common in connective tissue diseases, whereas differences in ectopic beats, arrhythmias, QRS duration and QRS axis and R wave amplitude were not significant. The only significant difference between the steroid-treated patients and those without such treatment was the higher frequency of ST changes in the steroid-treated group. The results imply that heart affection is common in all connective tissue diseases. The several mechanisms underlying the cardiac involvement are reflected in many ways in the electrocardiograms of these patients, including an increased frequency of ECG changes mimicking those met in coronary heart disease.