# 4960
As I read the abstract of the following study, I was reminded of the admonition many years ago by my paramedic cardiology-instructor to `always treat the patient . . . not the rhythm strip’.
It appears that worrisome abnormal EKG (or ECG) readouts may occur among a significant percentage of novel H1N1 cases that present at the hospital, without there being a serious underlying cardiac involvement.
The study appears in the latest edition of the Journal of American Cardiology.
Electrocardiographic Abnormalities in Patients With Novel H1N1 Influenza Virus Infection
Akritidis N, Mastora M, Baxevanos G, et al. Electrocardiographic abnormalities in patients with novel H1N1 influenza virus infection. Am J Cardiol 2010; DOI: 10.1016/j.amjcard.2010.06.078. Available at: http://www.ajconline.org.
EXCERPT:
Of the 50 patients, 14 (28%) exhibited ECG changes on admission. Nine patients presented with T-wave inversions, while ST-segment depression was observed on the electrocardiograms of 6 patients.
The presence of ECG changes did not correlate with age, gender, co-morbidities, the laboratory profiles of the patients, or the coexistence of lower respiratory tract involvement.
Although influenza-related EKG changes have been rarely observed in the past, they have usually been associated with an inflammation of the heart muscle – myocarditis – which is not the case here.
Additional testing using ultrasonography ruled out other possible causes including pericarditis, mitral-valve prolapse, or alterations in left ventricular contractility.
Cardiac enzyme panels remained normal for practically all of the cases studied, and the aberrant EKGs reversed themselves as the patients recovered - indicating an unusual but apparently benign presentation.
For more on this study, you may wish to read the following from TheHeart.org
Despite the title of the above article, novel H1N1 has been linked to cardiac damage and/or myocarditis on rare occasions (see Possible link between H1N1 flu and myocarditis).
As to why novel H1N1 should alter some people’s EKG?
Well, according to TheHeart.org article, Akritidis et al provide a couple of possibilities, including:
"The alterations observed in our series may also reflect transient ischemia or the effect of systemic inflammatory response on the myocardium.
Irrespective of the pathogenetic mechanism involved, however, all changes observed were transient."
