Clinical and electrocardiographic characteristics in patients with fulminant myocarditis

Tomonori Itoh; Takamasa Kobayashi; Yuya Oshikiri; Yumeka Arakawa; Mamoru Satoh; Yoshihiro Morino

doi:10.1002/joa3.12751

Clinical and electrocardiographic characteristics in patients with fulminant myocarditis

J Arrhythm. 2022 Jul 8;38(5):763-771. doi: 10.1002/joa3.12751. eCollection 2022 Oct.

Authors

Tomonori Itoh^{1

2}, Takamasa Kobayashi¹, Yuya Oshikiri¹, Yumeka Arakawa³, Mamoru Satoh⁴, Yoshihiro Morino¹

Affiliations

¹ Division of Cardiology, Department of Internal Medicine Iwate Medical University Shiwa-gun Japan.
² Division of Community Medicine, Department of Medical Education Iwate Medical University Shiwa-gun Japan.
³ School of Medicine Iwate Medical University Shiwa-gun Japan.
⁴ Division of Biomedical Information Analysis, Institute for Biomedical Sciences Iwate Medical University Shiwa-gun Japan.

Abstract

Background: The purpose of this study was to evaluate clinical and electrocardiographic characteristics in patients with fulminant myocarditis.

Methods: A total of 72 patients were divided into three groups: pericarditis (control: n = 25), acute myocarditis (n = 27), and fulminant myocarditis (n = 20). Patients' characteristics and electrocardiograms on admission were retrospectively analyzed in the three groups.

Results: BNP levels in the fulminant group were significantly higher than those in the other two groups. ST elevation was observed at lead aVR in the fulminant myocarditis group, whereas ST depression was observed at lead aVR in the other groups (p = .001). The maximum degree of ST elevation among the three groups was similar. However, the number of ST-elevation leads in the fulminant myocarditis group was significantly lower than that in the other groups (p = .004). The voltage of R wave in lead V5 in the fulminant myocarditis group was significantly lower than that in the other groups (p = .005). Moreover, in the Cabrera sequence, the prevalence of ST elevation in the inferior leads, aVR, and V3-V6 in the fulminant myocarditis group was significantly or nearly significantly lower than that in the other groups.

Conclusions: In fulminant myocarditis, ST-segment elevation was observed in lead aVR, and contrarily, the number and extent of ST-segment elevation and R wave voltage were smaller than those in the other groups. These results suggest that the number of myocytes with maintained action potential may be reduced following progressive myocardial damage and interstitial edema due to severe inflammation.

Keywords: ST elevation; acute myocarditis; electrocardiography; fulminant myocarditis; pericarditis; prognosis.