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Through the examination of 171 electrocardiograms (ECG) of 101 patients with primary pulmonary hypertension (PPH), the following conclusions were obtained. Arrhythmias were found in 27 (26.7%) of the 101 patients. Among the surviving cases, arrhythmias were found in 8 (17.8%) out of 45 patients, but among the deceased cases, the figure was higher, 19 (33.9%) out of 56. There were instances of more than one kind of arrhythmias in the same patient and a total of 34 types of arrhythmias were noted. The main types of arrhythmias were sinus tachycardia (13 cases), sinus bradycardia (6 cases), and first degree A-V block (5 cases), which accounted for 70% of the total. Sinus tachycardia was observed in only 2 of the survivors but in 11 of the deceased cases, which showed a significant difference (p<0.05). First degree A-V block were all induced by digitalis. Wenckebach type of second degree A-V block was noted in only 1 case and it was also induced by digitalis. Since severe attacks of ventricular arrhythmias were very rare in these cases with PPH, it is difficult to consider the Adams-Stokes syndrome as the cause of syncopal attacks or sudden death. However, it is necessary to further investigate nodal functions by means of continuous ECG monitoring, the overdrive suppression test and His bundle ECGs.

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In order to evaluate the pulmonary hemodynamics in primary pulmonary hypertension, the relation between the standard 12-lead electrocardiogram (ECG) and pulmonary hemodynamics as determined by right-heart catheterization was analyzed. Significant positive correlations were noted between amplitude of the R in V1, the R/S ratio in V1, and the pulmonary artery systolic pressure (r = 0.46 and 0.50, respectively, p less than 0.01). An amplitude of the R in V1 of more than 1.2 mV indicated a pulmonary artery systolic pressure of more than 90 mmHg with a sensitivity of 94% and a specificity of 47%. The cardiac index showed a significant positive relationship with amplitude of the R in V5 and V6 and the R/S ratio in V5 and V6 (r = 0.46, 0.46, 0.39, and 0.48, respectively; each with a p less than 0.01). Moreover, an AQRS greater than or equal to 100 degrees, and either an SV6 greater than or equal to 0.7 mV, or R/SV6 less than or equal to 2 indicated a cardiac index of less than 2.8L/min/m2 with a sensitivity of 82% and 84% and a specificity of 86% and 100% respectively. This study suggests, therefore, that the 12-lead ECG is useful for the evaluation of the severity of pulmonary hypertension by its ability to predict pulmonary artery systolic pressure and cardiac index with clinically useful accuracy.