ECG Case 021
75-year old smoker presenting with acute dyspnoea and productive cough. Describe the ECG.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
This ECG demonstrates many of the features of chronic pulmonary disease:
- Rightward QRS axis (+90 degrees)
- Peaked P waves in the inferior leads > 2.5 mm (P pulmonale)
- Rightward P-wave axis (inverted in aVL)
- “Clockwise rotation” of the heart with a delayed R/S transition point (transitional lead = V5)
- Absent R waves in the right precordial leads (SV1-SV2-SV3 pattern)
- Low voltages in the left-sided leads (I, aVL, V5-6)
Tachycardia may be due to dyspnoea, hypoxia or beta-agonist treatment. This ECG pattern is a common finding in patients with COPD. The inferior axis (+90 degrees) is due to hyperinflation of the lungs causing vertical orientation of the heart.
References
Further Reading
- Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course. Understand ECG basics. Medmastery
- Wiesbauer F, Kühn P. ECG Mastery: Blue Belt online course: Become an ECG expert. Medmastery
- Kühn P, Houghton A. ECG Mastery: Black Belt Workshop. Advanced ECG interpretation. Medmastery
- Rawshani A. Clinical ECG Interpretation ECG Waves
- Smith SW. Dr Smith’s ECG blog.
- Wiesbauer F. Little Black Book of ECG Secrets. Medmastery PDF
TOP 100 ECG Series
Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |
MBBS DDU (Emergency) CCPU. Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Co-creator of the LITFL ECG Library. Twitter: @rob_buttner
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I note these are considered absent R waves in V1-3, but what differentiates this from being called pathological Q waves with ST elevation in leads V1-3, with reciprocal ST depression in leads II, III, aVF? Thank in advance for clarifying!
What about aVR?