From the Guidelines
Pulmonary disease pattern on an electrocardiogram (ECG) signifies right ventricular hypertrophy (RVH) and strain, often associated with conditions such as pulmonary arterial hypertension (PAH) and chronic obstructive pulmonary disease (COPD).
Key ECG Findings
- Right axis deviation
- Tall R wave and small S wave with R/S ratio ≥ 1 in lead V1
- qR complex in lead V1
- rSR’ pattern in lead V1
- Large S wave and small R wave with R/S ratio ≥ 1 in lead V5 or V6
- ST-T segment wave depression and inversion in the right precordial leads
- P pulmonale, indicating right atrial enlargement
- Low voltage in the limb leads, a frontal plane QRS axis that is rightward, superior, or indeterminate, and a rightward P-wave axis in patients with COPD 1
Diagnostic Considerations
The ECG is not a sensitive tool for diagnosing PAH, with a sensitivity of 55% for RV hypertrophy and 70% for specificity 1. However, it can provide supportive evidence of PH, particularly in severe cases 1. A normal ECG does not exclude the diagnosis of PH.
Clinical Context
In patients with suspected PH, the ECG should be used in conjunction with other diagnostic tests, such as transthoracic echocardiography, pulmonary function tests, and right heart catheterization, to confirm the diagnosis and evaluate the severity of the disease 1.
From the Research
Pulmonary Disease Pattern on Electrocardiogram (ECG)
A pulmonary disease pattern on an electrocardiogram (ECG) can signify various abnormalities, including:
- Right atrial enlargement (RAE) 2, 3, 4
- Right ventricular hypertrophy (RVH) 2, 4
- Right bundle branch block (RBBB) 2, 3
- Marked clockwise rotation of the heart 2
- Low voltage in limb leads 2
- A QS pattern in leads III and aVF 2
- Left axis deviation (LAD) 2, 4
- Premature atrial complexes (PACs) 2
- Supraventricular tachyarrhythmias (SVTs) 2
- P-wave changes, including increased amplitude and rightward shift of the P-wave axis 5
- QRS abnormalities, including right-axis deviation and S(1)S(2)S(3) pattern 3
- Nonspecific ST-segment or T-wave changes 3, 4
Specific Patterns in Chronic Obstructive Pulmonary Disease (COPD)
In patients with COPD, the following ECG patterns are commonly observed:
- Transition zone 4
- Low QRS voltage 4
- P pulmonale 4
- T-wave inversion in leads V1-V3 4
- S1S2S3 syndrome 4
- QT interval changes 4
Comparison with Pneumonia
ECG findings in patients with pneumonia are similar to those in patients with pulmonary embolism (PE) and include: