The electrocardiogram in emphysema with and without chronic airways obstruction.

Clinical and postmortem data were analyzed on 31 patients found at necropsy to have relatively pure emphysema Criteria were sought to distinguish electrocardiographic changes due to emphysema unattended by disabling clinical manifestations from those changes due to emphysema attended by chronic airway obstruction (CAO). None of six patients without clinical evidence of CAO had right ventricular hypertrophy (RVH). Two of eight with mild or questionable nondisabiing CAO had such hypertrophy, as had 16 or 17 with severe disabling CAO. Established criteria f a ECG identi6cation of RVH are too stringent to permit optimal use of this diagnostic measure in patients with emphysema and other chronic pulmonary disorders. Utilizing primarily a vectorial approach to the scalar electrocardiogram, we have derived six criteria which were found to be of assistance in predicting anatomic RVH from the ECG. These were rightward P vector, P-pulmonale, rightward initial, terminal and mean QRS vectors, and a posteriorly directed, horizontal QRS vector. ECG changes associated with emphysema in the absence of disabling chronic airway obstruction and pulmonary hypertension are limited to low voltage and perhaps "pseudo left axis deviation." Our data indicate it is emphysema attended by severe airway obstruction with accompanying pulmonary hypertension and RVH which, in the individual patient, produces some or all of the ECG changes listed here.