ECG changes in CHRONIC OBSTRUTIVE PULMONARY DISEASES Synonyms:Emphysema, Chronic bronchitis, Chronic Obstructive Lung Disease (COLD), Chronic Obstructive Airway Disease (COAD), Smokers Lung

ECG changes in CHRONIC OBSTRUTIVE PULMONARY DISEASES

Synonyms:Emphysema, Chronic bronchitis, Chronic Obstructive Lung Disease (COLD), Chronic Obstructive Airway Disease (COAD), Smokers Lung

DR.PRITHVIRAJ METHERESIDENT IN PULMONARY MEDICINE

DEFINITIONCOPD is a lung disease characterized by airflow limitation (FEV1/FVC ratio of less than 70%)that is not fully reversible (FEV1 increase of 200 ml and 12% improvement above baseline FEV1 following administration of either inhaled corticosteroids or bronchodilators). COPD comprises of 2 predominant conditions Chronic bronchitis and Emphysema.Chronic Bronchitisis defined as a productive cough for 3 months in each of 2 successive years in a patient whom other causes of chronic sputum has been excluded.Emphysemais defined as the presence of enlargement of airspaces distal to the terminal bronchioles or acinus with destruction of their walls without obvious fibrosis.

Mechanism of ECG changes in COPDCOPD is associated with increased airway resistance, alveolar and pulmonary capillary destruction, air trapping, chronic hypoxemia and increased work of breathing. In an attempt to improve oxygenation of the blood, pulmonary vessels adjacent to underventilated alveoli tend to constrict (hypoxic reflex pulmonary vasoconstriction), increasing both pulmonary vascular resistance and the work of right heart i.e. COPD imposes chronic strain on the right side of heart resulting in cor pulmonale.

COPD and Heart

Elongation and vertical orientation of the heart:Hyperexpanded lungs impose external compression of heart and lowering of diaphragmsClockwise rotation of heart in the transverse plane:Due to its fixed attachment to the great vesselsReduced amplitude of the QRS complexes:Due to dampening effect resulting from increased air between the heart and recording electrodes

ECG findings of right atrial and right ventricular enlargement are seen with COPD (The long-term effects of hypoxic pulmonary vasoconstriction upon the right side of the heart, causing pulmonary hypertension and subsequent right atrial and right ventricular hypertrophy)

ECG changes Underlying causeP pulmonale (Tall, peaked P-wave 2.5 mm height in inferior leads II, III and aVF)ECG changesUnderlying causeP pulmonale (Tall, peaked P-wave 2.5 mm height in inferior leads II, III and aVF)Right atrial abnormalityIncreased R wave voltage in leads V1, V2Right ventricular enlargementRight axis deviation usually between +90 and +180Right ventricular dilationLow voltage QRS complex (+90QRS amplitudeless than 5 mm in V5, V6S1-S2-S3 pattern with R/S