From the Guidelines
An electrocardiogram (EKG) cannot definitively diagnose carditis on its own, but it can help detect it by showing nonspecific abnormalities such as ST segment changes, T wave inversions, conduction delays, or arrhythmias. For a definitive diagnosis of carditis, additional tests are typically required, including echocardiography to assess heart function and structure, cardiac MRI to visualize inflammation, blood tests for inflammatory markers, and sometimes cardiac biopsy for direct tissue examination. EKG serves as a valuable initial screening tool that can raise suspicion for carditis and guide further diagnostic workup, especially when interpreted alongside clinical symptoms like chest pain, shortness of breath, or fever 1. However, it's essential to understand that normal EKG findings don't rule out carditis, as some cases may not produce detectable electrical abnormalities, particularly in early stages of the condition. Some key points to consider when evaluating carditis include:
- The inclusion of CMR, with T2-weighted imaging, parametric mapping, and late gadolinium enhancement, has emerged as standard of care in the initial assessment and clinical follow-up of myocarditis 1.
- Impaired LVEF also predicts adverse outcomes, and late gadolinium enhancement indicates inflammation or necrosis, early fibrosis, and a potential arrhythmia substrate promoting adverse LV remodeling 1.
- Recent data suggest that resolution of inflammation, as initially detected by CMR, can occur 4 to 6 weeks after diagnosis, allowing for an earlier return to competitive sports 1. Given the most recent and highest quality study, the use of EKG as an initial screening tool, followed by more specific tests like CMR and echocardiography, is the recommended approach for diagnosing carditis 1.
From the Research
EKG Diagnosis of Carditis
- An electrocardiogram (EKG) can be used to diagnose certain types of carditis, such as pericarditis and myocarditis, as it can reveal specific changes like ST-segment elevations and PR-segment depressions 2, 3.
- However, there are cases where individuals show all symptoms of carditis yet present an atypical or irregular EKG, highlighting the importance of a comprehensive diagnostic approach 2.
- In patients with acute myocarditis, EKG can display a variety of non-specific abnormalities, but it is still widely used as an initial screening tool 3.
- The presence of certain EKG abnormalities, such as PR segment depression and ST elevation, can favor a diagnosis of perimyocarditis rather than myocardial infarction 3.
- EKG alterations in acute myocarditis can be useful in clinical practice for deciding appropriate therapy, length of hospitalization, and frequency of follow-up 3.
Limitations of EKG in Diagnosing Carditis
- EKG may not always provide definite proof of carditis, and other diagnostic tools like echocardiography may be necessary for an accurate diagnosis 2, 4.
- In some cases, EKG may be normal or show non-specific changes, making it difficult to diagnose carditis solely based on EKG findings 5.
- Echocardiography can be a useful tool in detecting carditis, especially in patients with acute rheumatic fever, and can help avoid overdiagnosis or underdiagnosis of carditis 4.
Clinical Context and EKG Findings
- The clinical context and presentation of the patient are crucial in interpreting EKG findings and making a diagnosis of carditis 6.
- A high index of suspicion and a comprehensive diagnostic approach are necessary to diagnose carditis accurately, especially in cases with atypical or non-specific EKG findings 2, 6.