P-wave changes in chronic obstructive pulmonary disease

Calatayud, Juan B.; Abad, José M.; Khoi, Nguyen Ba; Stanbro, William W.; Silver, Harold M.

doi:10.1016/0002-8703(70)90248-6

Cited by 37 publications

(20 citation statements)

References 27 publications

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“…bronchial asthma with change in position. A recent study on P wave amplitude has shown a positive correlation with radiological evidence of chronic obstructive lung disease but no relation with x-ray evidence of right or left ventricular enlargement (Calatayud et al, 1970). P pulmonale in this study did not correlate with right ventricular thickness or pulmonary artery pressure.…”

Section: Resultscontrasting

confidence: 81%

Electrocardiogram in chronic cor pulmonale.

Padmavati¹,

Raizada²

1972

Heart

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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...

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Section: Resultscontrasting

confidence: 81%

Electrocardiogram in chronic cor pulmonale.

Padmavati¹,

Raizada²

1972

Heart

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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%

“…Around 635 patients from the same ECG continuum were selected with P-wave axis <60° in sinus rhythm matched for age and sex serving as the control group (Table 1). Inclusion criteria were age >45 years, [1][2][3][4]7 NSR and availability of past medical history, imaging studies and/or pulmonary function tests. Patients <45 years old were excluded since vertical P-wave axis is a normal finding in healthy children and in many young adults.…”

Section: Methodsmentioning

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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“…[6][7][8][9][10] Several studies. [11][12][13][14][15] reported changes in the activity of heart including P-wave axis and amplitude, rightward displacement of QRS and T-axis, reduction of amplitude of QRS complex in limb and precordial leads, sinus tachycardia, Right bundle branch block (RBBB) etc., among COPD patients. However, COPD patients probably are not usually assessed by electrocardiogram in routine medical practice particularly in developing countries like India.…”

Section: Introductionmentioning

confidence: 99%