Electrocardiographic manifestations in a large right-sided pneumothorax

Electrocardiographic changes in pneumothorax: an updated review

ECG changes in pneumothorax have gained recognition as important indicators of cardiopulmonary interactions. This narrative review examines the existing literature to provide insights into the various ECG abnormalities observed in patients with pneumothorax, their underlying mechanisms, and clinical implications. The review highlights the commonly reported changes, including alterations in the electrical axis, ST segment deviations, T-wave abnormalities, and arrhythmias. The rightward shift of the electrical axis is attributed to cardiac displacement caused by increased intrathoracic pressure. ST segment deviations may reflect the influence of altered intrathoracic pressure on myocardial oxygen supply and demand. T-wave abnormalities may result from altered myocardial repolarization and hypoxemia. Arrhythmias, although varying in incidence and type, have been associated with pneumothorax. The clinical implications of these ECG changes are discussed, emphasizing their role in diagnosis, risk stratification, treatment optimization, and prognostication. Additionally, future research directions are outlined, including prospective studies, mechanistic investigations, and the integration of artificial intelligence. Enhancing our understanding of ECG changes in pneumothorax can lead to improved patient care, better management strategies, and the development of evidence-based guidelines. The objective of this review is to demonstrate the presence of various ECG abnormalities in patients with pneumothorax.

Accidental Hypothermia-Induced J Wave Coupled With Giant R Wave Augmented by Premature Atrial Contraction: A Case Report

The 12-lead electrocardiographic findings in hypothermia include the presence of J waves; prolongation of the PR, QRS, and QT intervals; and atrial and ventricular dysrhythmias. Among these findings, the J wave, known as the Osborn wave, is considered pathognomonic. In 1953, the J wave was reported as a specific response to hypothermia in dogs, representing the current at the site of injury instead of a widening of the QRS complex that occurs caused by a conduction delay. The J wave is often accompanied by ventricular fibrillation. For the past 28 years, it was assumed that the hypothermia-induced J wave was mediated by the transient outward current. However, it was recently been reported that the J waves in some patients with hypothermia can be considered delayed conduction-related waveforms. Here, we present a case of hypothermia-induced J waves together with giant R waves, which have not been previously reported during hypothermia, augmented by short RR intervals arising from premature atrial contractions. Our observations indicate that the underlying mechanism for the genesis of J waves is indeed conduction delay and not transient outward currents.

Electrocardiographic changes in a right-sided pneumothorax

A pneumothorax is an extrapulmonary air accumulation within the pleural space between the lung and the chest wall. Symptoms usually reported include dyspnoea and chest pain. However, there are many life-threatening conditions with the same symptomology making early pneumothorax diagnosis challenging, such as acute coronary syndrome. Electrocardiogram (ECG) changes caused by left and right sided pneumathoraces have been reported, but awareness remains poor. This case describes a 51-year old male who presented with a right-sided pneumothorax, new ECG changes and elevated troponin. The case highlights the importance of recognising right-sided pneumothorax-associated ECG manifestations in patients presenting with acute chest symptoms.

ECG Changes in a Patient Presenting With Chest Pain Secondary to Left-Sided Primary Spontaneous Pneumothorax: A Case Report-Based Literature Review

Pneumothorax is the accumulation of air in the extrapulmonary space between the pleura and the chest wall. Spontaneous pneumothorax can present with various electrocardiographic (ECG) findings including axis deviation, bundle branch block and T waves inversion. A 23-year-old young male patient of slim build presented to the accident and emergency department with sudden-onset chest pain and shortness of breath. He had pleuritic chest pain, worse on breathing. Electrocardiogram showed right axis deviation, diminished or low-amplitude R waves and small-amplitude QRS complexes in the precordial leads. Vital signs were stable and physical examination showed reduced air entry on the left side. Chest radiography showed significant left-sided pneumothorax and the patient had an emergency chest drain inserted. ECG changes resolved with the resolution of pneumothorax. He was discharged home after four days of hospital admission and complete resolution of pneumothorax.

Electrocardiographic changes in Emphysema

Chronic obstructive lung disease (COPD), predominantly emphysema, causes several thoracic anatomical and hemodynamic changes which may cause changes in various electrocardiographic parameters. A 12-lead electrocardiogram (ECG), which is often a part of routine evaluation in most clinical settings, may serve as a useful screening modality for diagnosis of COPD or emphysema. Our current article aims to provide a comprehensive review of the electrocardiographic changes encountered in COPD/emphysema utilizing published PubMed and Medline literature database. Several important ECG changes are present in COPD/emphysema and may serve as a good diagnostic tool. Verticalization of P-vector, changes in QRS duration, pattern recognition of precordial R-wave progression and axial shifts can be considered some of the most valuable markers among other changes. In conclusion, 12-lead surface electrocardiogram can serve as a valuable tool for the diagnosis of COPD and/or emphysema. An appropriate knowledge of these ECG changes can not only help in the diagnosis but can also immensely help in an appropriate clinical management of these patients.

Usefulness of the Electrocardiogram in a Patient Presenting with Right-Sided Pneumothorax and Presyncope

We present the case of a 71-year-old man with history of smoking, pulmonary emphysema, hypertension, multivessel coronary artery disease and prior coronary artery bypass graft surgery who presented with spontaneous right-sided pneumothorax associated with phasic changes of the QRS amplitude on the electrocardiogram. While several case reports have described QRS amplitude changes associated with left-sided pneumothorax, reports of phasic ECG changes in right-sided pneumothorax are exceedingly rare. Such changes, when present in a patient with sudden onset chest pain and dyspnea, should prompt a diagnostic workup for possible pneumothorax.