Electrocardiogram in chronic cor pulmonale

Zuckermann, R; Enrique, Cabrera C.; Fishleder, B; Sodi‐Pallares, Demetrio

doi:10.1016/0002-8703(48)90118-5

Cited by 89 publications

(30 citation statements)

References 2 publications

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“…[1][2][3][4][5][6][7][8] A plausible mechanism for P-axis verticalisation in lung hyperinflation is that the right atrium is firmly attached to the diaphragm by a dense pericardial ligament around the inferior vena cava. 9 With progressive flattening of the diaphragm, the right atrium is distorted/displaced inferiorly causing a significant rightward deviation (verticalisation) of the P-wave axis.…”

Section: Discussionmentioning

confidence: 99%

Vertical P-wave axis: the electrocardiographic synonym for pulmonary emphysema and its severity

Chhabra

Sareen

Perli

et al. 2012

Indian Heart Journal

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A B S T R A C T Background:The correlation between vertical P-wave axis (P-axis > 60°) and pulmonary emphysema was investigated on a very large controlled series to see if P-axis verticalisation as lone criterion can be effectively used to screen emphysema in general population. Correlation between degrees of P-axis verticalisation and the severity of the obstructive lung disease (as per global initiative for chronic obstructive lung disease [GOLD] criteria) was also studied to see if this criterion can be used for gross quantification of the chronic obstructive pulmonary disease (COPD) in routine clinical practice. Materials and methods:Around 6500 unselected, routine electrocardiograms (ECGs) were reviewed which yielded 600 ECGs with vertical P-axis in sinus rhythm. 635 ECGs from the same continuum were selected with P-axis ≤60° matched for patient's age and sex serving as controls. Charts were reviewed for the diagnosis of COPD and emphysema based on medical history, pulmonary function tests, and imaging studies.Results: Prevalence of emphysema in patients with vertical P-axis was strikingly higher than in the control group: 85% vs 4.4%. The sensitivity and specificity of vertical P-axis for diagnosing emphysema was 94.76% and 86.47%, respectively. Vertical P-axis and forced expiratory volume (FEV1) were inversely correlated (Pearson correlation coefficient = -0.683). Prevalence of severe COPD was strikingly higher in patients with P-axis > 75° as compared to the group with P-axis 60°-75°: 96.3% vs 4.6%. Close to 80% of the emphysema patients with P-axis > 85° had very severe disease (FEV1 < 30%).Conclusion: P-axis verticalisation is highly effective for screening emphysema and degree of verticalisation provides a gross quantification of the disease.

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Section: Discussionmentioning

confidence: 99%

Vertical P-wave axis: the electrocardiographic synonym for pulmonary emphysema and its severity

Chhabra

Sareen

Perli

et al. 2012

Indian Heart Journal

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“…Pulmonary hemodynamics are related to P-wave height, 16 and changes in P-wave height from rest with exercise correlate with mean pulmonary artery pressure in patients with COPD. 10 Hida and col- leagues 10 showed that an increase in P-wave height was related to oxygen desaturation during exercise.…”

Section: Discussionmentioning

confidence: 99%

Exercise-induced desaturation and electrocardiogram changes in people with severe lung disease: An exploratory investigation of 25 serial cases

Jones¹,

Yu²,

Mok³

et al. 2006

Heart & Lung

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“…P-wave morphology, particularly in the inferior leads, can become tall and peaked (originally described as ‘gothic’7) with a height exceeding 2.5 mm and is known as ‘P-pulmonale’5 8 9 when accompanied by a P-wave axis to the right of +70°. These tall P-waves of P-pulmonale are usually attributable to right atrial enlargement and are often associated with right ventricular hypertrophy complicating pulmonary hypertension, COPD or congenital heart disease 10.…”

Section: Discussionmentioning

confidence: 99%