Electrocardiographic abnormalities in generalized tetanus

Transient electrocardiographic abnormalities occurred in eight cases of generalized tetanus. These included P wave changes, ST-T segment abnormalities, intraventricular conduction delay, inappropriate tachycardia, U waves, extrasystoles, low voltage, changing axis and electrical alternans. Each patient had more than one abnormality. Respiratory obstruction, anoxia, fever and abnormalities of blood gases and electrolytes were controlled when these electrocardiographic changes were recorded. Although these findings are non-specific, it is possible that they represent a direct effect on the myocardium by the tetanus toxin. Further studies to determine whether cardiac involvement is present and contributes to the high mortality of tetanus are needed.