title: Electrocardiographic changes in hospitalized patients with leptospirosis over a 10-year period.
abstract: BACKGROUND
  The aim of this study was to investigate the incidence and type of ECG changes in patients with leptospirosis regardless of clinical evidence of cardiac involvement.
  
  
  METHODS
  A total of 97 patients with serologically confirmed leptospirosis treated at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević" in Zagreb, Croatia, were included in this retrospective study. A 12-lead resting ECG was routinely performed in the first 2 days after hospital admission. Thorough past and current medical history was obtained, and careful physical examination and laboratory tests were performed.
  
  
  RESULTS
  Abnormal ECG findings were found in 56 of 97 (58%) patients. Patients with abnormal ECG had significantly elevated values of bilirubin and alanine aminotransferase, lower values of potassium and lower number of platelets, as well as more frequently recorded abnormal chest x-ray. Non-specific ventricular repolarization disturbances were the most common abnormal ECG finding. Other recorded ECG abnormalities were sinus tachycardia, right branch conduction disturbances, low voltage of the QRS complex in standard limb leads, supraventricular and ventricular extrasystoles, intraventricular conduction disturbances, atrioventricular block first-degree and atrial fibrillation. Myopericarditis was identified in 4 patients. Regardless of ECG changes, the most commonly detected infection was with Leptospira interrogans serovar Australis, Leptospira interrogans serovar Saxkoebing and Leptospira kirschneri serovar Grippotyphosa.
  
  
  CONCLUSIONS
  The ECG abnormalities are common at the beginning of disease and are possibly caused by the direct effect of leptospires or are the non-specific result of a febrile infection and metabolic and electrolyte abnormalities. New studies are required for better understanding of the mechanism of ECG alterations in leptospirosis.
authors.affiliation: Clinical Hospital Centre Zagreb, Sestre Milosrdnice University Hospital, Clinic of Internal Medicine, Zagreb, Croatia. bfm@bfm.hr
authors.forename: Vedrana
authors.initials: V
authors.lastname: Škerk
authors.forename: Alemka
authors.initials: A
authors.lastname: Markotić
authors.forename: Ivan
authors.initials: I
authors.lastname: Puljiz
authors.forename: Ilija
authors.initials: I
authors.lastname: Kuzman
authors.forename: Elvira
authors.initials: E
authors.lastname: Čeljuska Tošev
authors.forename: Josipa
authors.initials: J
authors.lastname: Habuš
authors.forename: Nenad
authors.initials: N
authors.lastname: Turk
authors.forename: Josip
authors.initials: J
authors.lastname: Begovac
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001281:Atrial Fibrillation / Q000209:etiology / Q000473:pathology*; D054537:Atrioventricular Block / Q000209:etiology / Q000473:pathology*; D001663:Bilirubin / Q000097:blood; D005117:Cardiac Complexes, Premature / Q000209:etiology / Q000473:pathology*; D017523:Croatia; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013616:Tachycardia, Sinus / Q000209:etiology / Q000473:pathology*
chemical_list: D000410:Alanine Transaminase; D001663:Bilirubin