Electrocardiogram in chronic cor pulmonale.

Abstract

A 14-year follow-up study of 544 patients with proven chronic cor pulmonale with 966 serial records was made. This is probably the largest series reported upon. Among significant serial changes were those in the configuration of the P and T waves which were the most labile and in the P and QRS axes which were less so. Right axis deviation of the P axis was found in 57 per cent, of the QRS axis in 79 per cent, and a qR pattern in aVR in 45 per cent. In the praecordial leads a classical right ventricular hypertrophy pattern was seen in nearly 75 per cent, incomplete right bundle-branch block in I5.4 per cent, a QS pattern in all chest leads in 17 per cent, left ventricular hypertrophy in 4-2 per cent, and combined ventricular hypertrophy in 4 per cent. The pattern of right ventricular hypertrophy was commonly a qR with R below 5 mm; Rs and R were much less common. qR and incomplete right bundle-branch block patterns interchanged freely in serial records and were sometimes present in the same record. The suggested reasons for these are a basic diastolic overload with a superimposed systolic overload, both of which are responsible for the genesis of the right ventricular hypertrophy pattern in cor pulmonale. An rS in V5-V6 was seen in 78 per cent of patients. Transient inversion of the T wave in all chest leads occurred in 23 per cent which could not be put down to digitalis or ventricular hypertrophy. These were ofa nonspecific nature, and might be related to the severity ofpulmonary artery hypertension, to hypoxia, and perhaps to pulmonary embolism.It is suggested that for the diagnosis of right ventricular hypertrophy in cor pulmonale when criteria of classical right ventricular hypertrophy and incomplete right bundle-branch block are absent, associated electrocardiographic abnormalities be taken. These are a combination of rS in V5-V6, right axis deviation, qR in aVR, and P pulmonale, the last being the least important.Though there have been several publications on the electrocardiogram in chronic cor pulmonale (Spodick, I959; Wood, I948; Phillips and Burch, I963; Burch and DePasquale, I963; Scott and Garvin, I941), many controversial points still exist in the diagnosis of right ventricular hypertrophy in the presence of extensive lung disease. Several of these electrocardiographic features have been attributed to inflationary changes in the lungs and to changes in cardiac position. The importance of being able to detect early cardiac involvement is obvious in relation to therapy.The records in the present series were evaluated with the following objectives. i) To study the evolution of the electrocardiogram in chronic cor pulmonale and to formulate criteria for detection of early right ventricular hypertrophy, particularly in hearts which are not enlarged. 2) To highlight special features of right venReceived 23 July I97I. tricular hypertrophy in chronic cor pulmonale as distinct from other causes. 3) To present the electrocardiographic features in perhaps the largest series of chronic cor pulmonale cases report...

Electrocardiographic and Echocardiographic Changes in Chronic Obstructive Pulmonary Disease (Copd) of Different Grades of Severity

“…13,15,16 Among the different RVH criteria, right axis deviation, R/S in V5/V6 <1, R/S in V1>1 were the commonest ECG changes, which according to different studies were important criteria or RVH.48% of the patients had p-pulmonale which according to some can be taken as indirect evidence of RVH. 8 On correlating the ECG findings with severity of the disease, it was found that, incidence of all ECG findings increased as the severity of the disease increased .Statistical correlation was found with p pulmonale, right axis deviation, incomplete RBBB, and RVH which was significant.(i.e. p<0.05).…”

“…7 The findings of ECG (Table 1) and echocardiography (table 2) were recorded. A 12 lead ECG was taken in all patients under study and following points were noted, 8,9 All patients were subjected to echocardiographic examination in 2D and M mode, to note the presence of pulmonary hypertension, RV hypertrophy, RV dilatation and RV failure. 7,10 RESULTS: A total of 50 cases were studied.…”

Assessment of cardiovascular changes among chronic obstructive pulmonary disease patients at rural tertiary care center of Northern India

“…[16] P pulmonale have been used as indirect evidence of RVH by various authors, other regarded it as a position changes in the heart due to hyperinflation, lowering of the diaphragm, and vertical position of the heart. [17] In this study, 30.5% (61/200) of the patients had ECG evidence of RVH, with criteria used as given by Braunwald. [18] Murphy and Hutcheson found 43.66%.…”

Prolonged hypoxemia after 10min walking exercise in aged patients with chronic obstructive pulmonary disease.

“…The P wave height of lead II of an electrocardiogram (ECG) without exercise was obtained according to the recommendations of the American Heart Association (1954), Padmavati and Raizada (1972) and mean P wave height from 5-10 beats was measured and used for analysis. The reference from which its voltage was measured was the isoelectric level of T-P interval.…”