Electrocardiographic changes in Emphysema

Figure 1 Electrocardiogram showing vertical P wave axis suggested by P wave amplitude in lead III greater than P wave in lead I and a negative P wave in lead aVL. Adapted from Bajaj et al[13].

Figure 2 Depiction of vertical P axis in Hexaxial reference system.

Figure 3 A schematic illustration of “P-pulmonale” (A), “Gothic” P waves (B) and normal “Cupola” P wave (rounded in contour).

Figure 4  Note the presence of right ventricular hypertrophy, significant P-terminal force and negative T waves in right precordial leads in this patient with pulmonary hypertension. Adapted from Yanowitz[39].

Figure 5 Right axis deviation of frontal plane QRS is noted along with P-pulmonale in a patient with pulmonary hypertension. Adapted from Yanowitz[39].

Figure 6 ECG of a patient with chronic lung disease showing precordial QRS changes suggestive of emphysema—poor R wave progression, R < 0. 5 mv in lead V6, R/S < 1 in lead V6 and S wave > 5 mm in leads V5-6. Also note—P-pulmonale, lead I sign and negative P in aVL. Adapted from Burns[40].

Figure 7 S1S2S3 pattern.

Figure 8 This is a schematic illustration of the axis-illusion phenomenon. A and B are frontal mean QRS axes of -90° and +90° respectively, suggesting a 180° divergence. Their sagittal projections reveal that this is illusory since they are actually much closer in space. Concept adapted from David Spodick’s work.

Figure 9 Schematic illustration of Lead I sign in emphysema.