Electrocardiographic Evidence of Cardiac Involvement in Acute Disease

Abstract

Daily electrocardiograms were taken on patients suffering from acute disease who received no digitalis or quinidine. (Table I.) No such systematic electrocardiographic study has been made except in rheumatic fever, 1 pneumonia, 2 and acute rheumatoid (infectious) arthritis. 3 The recorded abnormalities were produced during the illness. Transient changes in lead III only were not included in the table.

For control data, 50 cases of acute rheumatoid (infectious) arthritis, 6 cases of ulcerative colitis and 9 cases of peptic ulcer were chosen. In the former 2 groups the patients were acutely ill with fever. In all the control patients no abnormalities in T-, QRS-waves, or in RS-T transitions, no auricular flutter or fibrillation, no heart-block were observed. Hence, one may conclude that an acute illness with fever and tachycardia does not produce significant arrhythmias, increased P-R intervals, T-wave inversions or marked RS-T changes unless the myocardium is involved.

Most marked heart-block and the most frequent arrhythmias were observed in acute rheumatic fever but a larger number of patients with this disease was studied than in any other. In acute disseminated lupus erythematosis, in periarteritis nodosa, in Malta fever, in capillary toxicosis, bronchopneumonia, typhoid and acute rheumatic fever, T-wave changes were most frequent. It is suggested that some of these diseases may have similar pathological alterations in the myocardium of vascular nature and that they may produce permanent heart damage.

A very fast pulse occurred in many cases with severe myocardial involvement. In 7 cases of pulmonary tuberculosis, for example, with rates above 120 beats per minute, 6 disclosed abnormal electrocardiograms. In this disease the occurrence of a heart rate of over 120 beats per minute should suggest myocardial involvement.