Electrocardiographic Patterns in Pneumothorax

Armen, Robert N.; Frank, Thomas

doi:10.1378/chest.15.6.709

Cited by 31 publications

(20 citation statements)

References 5 publications

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“…ECG changes produced by spontaneous pneumothoraces have been well described as a diagnostic aid in the awake, spontaneously breathing patient [2][3][4]. However, in anaesthetised patients developing an intra-operative pneumothorax [5-71, this sign has not been alluded to, except in one case report [8].…”

Section: Discussionmentioning

confidence: 99%

Are electrocardiogram changes the first sign of impending peri‐operative pneumothorax?

Botz

Brock‐Utne

1992

Anaesthesia

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SummaryA patient in the right lateral position underwent left nephrectomy, after which he was placed supine for insertion of The diagnosis of intra-operative pneumothorax canThe peak inspiratory pressure was increased slightly from occasionally be difficult. We report a case where a decrease 14-16 cmH,O in the supine position to 20-22 cmH,O in electrocardiogram (ECG) amplitude was the first sign of when he was in the lateral position. The ECG demonthe event. This change occurred 25 min before a rapid strated sinus rhythm and was similar to the pre-induction deterioration in the patient's clinical condition necessitated ECG (Fig. I). Following nephrectomy he was moved to the urgent treatment.supine position in preparation for the A-V shunt placement. Re-assessment of airway and monitors showed no changes. Ten minutes later, during the preparation of the left upper arm, the lead I1 ECG tracing was noted to be dramatically reduced in amplitude (Fig. 2) when compared to the pre-induction tracing (Fig. I). Re-examination of the Case historyA 55-year-old male patient with progressive renal insufficiency and a left renal mass presented for left nephrectomy and arteriovenous (A-V) shunt placement. His past medical history included well-controlled hypertension, Crohn's disease, progressive renal insufficiency, and a history of cigarette smoking. Medications included atenolol and sulfasalazine. He underwent a n uncomplicated induction of anaesthesia and tracheal intubation. A radial arterial line was placed after induction of anaesthesia and he was positioned in the right lateral decubitus position for surgery. He remained haemodynamically stable during the nephrectomy with a mean arterial pressure (MAP) of 75-85mmHg, and an oxygen saturation (Spo,) of 98%.

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Section: Discussionmentioning

confidence: 99%

Are electrocardiogram changes the first sign of impending peri‐operative pneumothorax?

Botz

Brock‐Utne

1992

Anaesthesia

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“…The first reports on pneumothorax-related ECG changes were provided in certain previous studies [1,9]. Based on these studies, tuberculosis specialists were the first to be concerned with pneumothorax-related ECG changes.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically the use of artificial pneumothorax for the treatment of tuberculosis provided an opportunity to compare electrocardiograms obtained before and after induction of pneumothorax. However, in one study, the obtained ECG findings were less informative, as the researchers used few leads [1]. In another study, the researchers reported differences in ECG abnormalities between patients with artificial and those with spontaneous pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

“…Most physicians consider an acute coronary syndrome in patients with chest pain, dyspnea, and electrocardiographic (ECG) changes consisting of ST segment deviation or interventricular conduction delay findings, among other features. Interest in ECG changes in patients with pneumothorax began to develop in the first half of the 20th century, and many pulmonary tuberculosis patients managed with artificial pneumothorax were a common research focus [1]. A few years later, researchers were concerned owing to the overlapping patterns of ECG changes in between patients with pneumothorax and those with other serious diseases such as pulmonary embolism and myocardial infarction [2-4].…”

Section: Introductionmentioning

confidence: 99%

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Changes in electrocardiographic findings after closed thoracostomy in patients with spontaneous pneumothorax

Lee

Kim

et al. 2017

Clin Exp Emerg Med

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ObjectiveWe aimed to describe electrocardiographic (ECG) findings in spontaneous pneumothorax patients before and after closed thoracostomy.MethodsThis is a retrospective study which included patients with spontaneous pneumothorax who presented to an emergency department of a tertiary urban hospital from February 2005 to March 2015. The primary outcome was a difference in ECG findings between before and after closed thoracostomy. We specifically investigated the following ECG elements: PR, QRS, QTc, axis, ST segments, and R waves in each lead. The secondary outcomes were change in ST segment in any lead and change in axis after closed thoracostomy.ResultsThere were two ECG elements which showed statistically significant difference after thoracostomy. With right pneumothorax volume of greater than 80%, QTc and the R waves in aVF and V5 significantly changed after thoracostomy. With left pneumothorax volume between 31% and 80%, the ST segment in V2 and the R wave in V1 significantly changed after thoracostomy. However, majority of ECG elements did not show statistically significant alteration after thoracostomy.ConclusionWe found only minor changes in ECG after closed thoracostomy in spontaneous pneumothorax patients.

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“…11 In one study, 40% of the study group with a PTX on the right side had lowered QRS voltage and 70% of the study group with a PTX on the left side had lowered QRS voltage.…”

Section: Diagnosis Of Spontaneous Pneumothoraxmentioning

confidence: 97%

Diagnosis and Management of Spontaneous Pneumothorax in the Emergency Department: A Review of the Most Current Clinical Evidence for Diagnosis and Treatment

Chong¹,

Chao²,

Hunter-Behrend³

et al. 2016

Pulm Res Respir Med Open J

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Background: Spontaneous non-traumatic pneumothorax is a relatively common clinical presentation in the Emergency Department. The diagnosis of spontaneous non-traumatic pneumothorax has evolved from basic chest radiography to the reference standard of CT imaging. Point-of-care ultrasound is another highly sensitive diagnostic modality that has gained increasing acceptance. Finally, the treatment of this type of pneumothorax has also been rapidly changing. Objective: We give an overview of the current literature regarding the definition and classification for pneumothorax. We discuss the current methods of diagnosis and management of spontaneous non-traumatic pneumothorax, which now include the promising treatment alternative of smaller pigtail thoracostomy catheters. We also discuss how a rapidly placed smaller pigtail catheter may be a viable single management option for a spontaneous tension pneumothorax. Discussion: The management of spontaneous non-traumatic pneumothorax has been rapidly advancing. Viable treatment options now include observation alone, needle aspiration and placement of a small pigtail thoracostomy catheter, in addition to the use of a traditional thoracostomy tube. Conclusion: Although the traditional treatment for a spontaneous non-traumatic pneumothorax was placement of a larger thoracostomy tube, this may no longer be the optimal management approach in these patients. The use of smaller pigtail thoracostomy catheters provides a viable treatment alternative to these larger catheters, and may also be used effectively as the only treatment step in a spontaneous tension pneumothorax. Placement of these smaller catheters sets the stage for potential outpatient management of pneumothorax, with increased comfort for the patient and possible cost savings.

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Electrocardiographic Patterns in Pneumothorax

Cited by 31 publications

References 5 publications

Are electrocardiogram changes the first sign of impending peri‐operative pneumothorax?

Are electrocardiogram changes the first sign of impending peri‐operative pneumothorax?

Changes in electrocardiographic findings after closed thoracostomy in patients with spontaneous pneumothorax

Diagnosis and Management of Spontaneous Pneumothorax in the Emergency Department: A Review of the Most Current Clinical Evidence for Diagnosis and Treatment

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