Pulmonary Emphysema: Classic, Quasi‐Diagnostic ECG

Abstract

T he patient was a 62-year-old heavy smoker who presented to the emergency department with acute dyspnea. Pulmonary function tests were subsequently positive for severe obstructive lung disease. The ECG shows a vertical (over +60 degrees) P-wave axis, which, by itself, is about 90% specific for emphysema in men and women older than 45 years. The vertical P axis induces a single-peaked P wave in leads II, III, and aVF. Lead II shows P pulmonale (P wave ≥2.5-mm amplitude), which is usually, as it is here, an emergency department phenomenon, disappearing with early treatment (NOTE: the vertical P axis is permanent). Another typical finding is narrow QRS complexes, shown here <70 milliseconds. The combination of vertical P axis and vertical narrow QRS was 96% specific for emphysema in a recent investigation. The peaked T waves are nonspecific, probably an adrenergic response.

Analysis of electrocardiogram in chronic obstructive pulmonary disease patients

“…Right ventricular hypertrophy (RVH) (right axis deviation, QRS < 0.12s, predominant R wave in lead V1, deep S in V6, inverted T waves in right praecordial leads -V2, V3, evidence of right atrial enlargement) 5. Left bundle branch block (LBBB): QRS duration must be ≥ 120 ms, rS with upright T wave in V1, V5 and V6 predominantly upright with inverted T, lead I predominantly upright with inverted T. 6. T-wave inversion (negative T waves) in leads V1-V3 as a signs of ischemia 7.…”

“…So far, there have been several studies on ECG characteristics in COPD and the criteria have been made accordingly [4]. COPD produces characteristic ECG changes as a result of pulmonary vasoconstriction due to hypoxemia, following pulmonary hypertension and enlargement of right ventricle as well as a dampening effect due to the presence of increased air between the heart and recording electrodes [5,6].…”

United in Prevention-Electrocardiographic Screening for Chronic Obstructive Pulmonary Disease

“…It has been known for some time that emphysema of any etiology, mostly due to chronic obstructive pulmonary disease, produce a state of abnormal lung hyperinflation leading to vertical frontal P-wave axis especially in adults, exceeding 60° (2, 3). A vertical P wave axis (>60 degrees) on a surface 12- lead electrocardiogram during sinus rhythm can be easily determined by observing P wave amplitude in limb leads I and III or aVL.…”