A Dynamic Electrocardiographic Concept Useful in the Diagnosis of Cor Pulmonale
Result of a Survey of 200 Patients with Chronic Obstructive Pulmonary Disease
The results of a survey of 200 patients with chronic obstructive pulmonary disease (COPD) revealed that the electrocardiographic criteria used in the past are relatively poor delineators of cor pulmonale in COPD, either in its early or late stages. The study offers a dynamic concept designed to aid in discovering right ventricular (RV) complications in COPD-the coupling of arterial blood gas analysis and four electrocardiographic fluctuations which signal RV abnormality. Where arterial O2 saturation fell below 85% and pulmonary artery mean pressure (PAm) was 25 mm Hg or greater, one or more of these four fluctuations were seen in patients with cor pulmonale: (1) a rightward shift of the mean QRS axis of 30° or more; (2) T-wave abnormalities in right V leads; (3) ST depressions in leads II, III, and aVF; and (4) transitory right bundle-branch block. With recovery of better arterial saturation and decrease in PAm they subsided. Thus, a clinical appraisal of patients with COPD should include serial analyses of arterial blood gas plus serial electrocardiograms if early (and hence reversible) RV abnormality and cor pulmonale are to be uncovered.
- Received December 18, 1969.
- Accepted June 30, 1970.
- © 1970 American Heart Association, Inc.