Electrocardiographic changes in Emphysema

Abstract

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.

Keywords: Emphysema; Chronic obstructive pulmonary disease; Electrocardiogram; P-wave axis; Sensitivity; Specificity

Core Tip: Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality in the United States. With COPD, a timely diagnosis and treatment are crucial to prevent increasing severity. COPD can cause electrocardiographic changes due to factors including lung hyperinflation. These changes can be present on the electrocardiograms of patients without COPD; however, specific parameters not seen in those with COPD will be indicative of other diseases such as congenital heart disease. The present review focuses on the use of 12-lead electrocardiogram with an emphasis on vertical frontal plane P-wave axis, combined with other minor abnormalities, which can aid in the diagnosis of COPD.