Prognosis in severe chronic obstructive pulmonary disease with regard to the electrocardiogram

The electrocardiogram in chronic obstructive pulmonary disease

The electrocardiogram is often abnormal in patients who have chronic obstructive pulmonary disease. The most frequent abnormalities are a rightward P-wave axis (greater than or equal to 70 degrees) and a rightward QRS axis (greater than or equal to 90 degrees). In addition, low voltage in the limb leads, an S1S2S3 pattern, poor R-wave progression, a posterior-superior terminal QRS vector or other changes may be present. Transient atrial and ventricular dysrhythmias are common. Knowledge of the usual electrocardiographic manifestations of chronic obstructive pulmonary disease enables the clinician to recognize uncharacteristic abnormalities, which often represent the effects of superimposed illnesses or drug toxicity.

The role of oesophageal electrocardiography in the diagnosis of right ventricular hypertrophy in chronic obstructive pulmonary disease

Oesophageal electrocardiograms were recorded in 25 normal persons, 20 patients with chronic bronchitis and predominant emphysema without right ventricular hypertrophy and 25 patients with chronic cor pulmonale as an end result of chronic obstructive pulmonary disease. At ventricular level, patients with chronic cor pulmonale had higher P wave height, lower Q wave depth, lower R wave height, deeper S waves and lower R/S ratio as compared to the group with emphysema. In terms of the transitional zone, patients with cor pulmonale had smaller Q waves and a lower Q/R ratio. At atrial level, the patients with cor pulmonale had higher heights of the P and R waves and a lower Q/R ratio. All these differences were highly significant statistically (P less than 0.001). An R/S ratio of less than 2.5 at ventricular level had high sensitivity (96.0%), specificity (100%) and accuracy (98%) in diagnosing right ventricular hypertrophy in cases of chronic obstructive pulmonary disease. This criterion obtained from the oesophageal electrocardiogram is much more sensitive and accurate than those obtained routinely from the surface electrocardiogram in diagnosing right ventricular hypertrophy in cases of chronic obstructive pulmonary disease.

Vectorcardiographic and blood pressure correlates of obstructive pulmonary diseases in a community population

Vectorcardiography was performed on 2,449 subjects, aged six years and older, in the Tucson (Ariz) Epidemiological Study of Airway Obstructive Diseases (AOD), 95 percent of the white non-Mexican Americans in the stratified cluster population sample. The objectives were to confirm previous relationships and to determine if hypothesized changes in the vectorcardiogram (VCG) could predict AOD. Trained nurse technicians performed the VCGs, which were read and interpreted by a cardiologist. Vectorcardiographic results were broadly interpreted for abnormalities. Also, calculated vector means and angles were compared to standard questionnaire responses for medical history, to maximum expiratory flow-volume variables, and to values for blood pressure; these were all corrected for sex, age, height, weight, and the ponderal index. Values were expressed as percentages of predicted. Over 80 percent of the VCGs were found to be normal. Measured hypertrophy was related to disease; there were significantly more abnormalities in those with histories of heart disease, hypertension, arteriosclerosis, and AOD, when examined by types of ventricular hypertrophy and VCG-identified heart disease or hypertension; findings of AOD and heart disease were also correlated significantly. Of all the ventricular hypertrophy, right ventricular hypertrophy (RVH), type C, was confirmed to be the predominant type associated with decreased pulmonary function in all smoking groups. Systolic blood pressure was related to RVH, type A, and diastolic 4 and 5 blood pressure with RVH, types A and B. The vectors' magnitude and angles were related to abnormality of pulmonary function in those with and without heart disease and AOD.