Studies of Electrocardiographic Diagnosis of Right Ventricular Hypertrophy and of the Incidence of Arrhythmias and Left Ventricular Abnormalities in Patients with Chronic Obstructive Pulmonary Disease with Moderate to Severe Pulmonary Hypertension

In 28 hospitalized patients with chronic obstructive pulmonary disease (COPD) with a pulmonary artery mean pressure (PAm) over 18 mmHg, incidence of electrocardiographic pattern of right ventricular hypertrophy (RVH) and the prevalence of arrhythmias and left ventricular abnormalities were studied on a total of 146 electrocardiograms.
Our new single criteria for electrocardiographic diagnosis of RVH in COPD was mean QRS axis between 90゜ and 180゜ or between -180゜ and -80゜. The majority diagnosed as RVH had a PAm of over 27 mmHg. In 7 patients, pulmonary artery wedge pressure (WP) was over the normal value. However, all patients except one with high WP showed no abnormality in left precordial leads. Twelve tracings of 146 (8%) showed arrhythmias. However, only one with transcient atrial fibrillation, the next day showed sinus rhythm with frequent supraventricular premature beats (SVPB). Other arrhythmias observed were all infrequent (less than 5 per minute) SVPB or VPB. Prevalence of arrhythmias on electrocardiograms of our patients with COPD was markedly less than the reported prevalences of hospitalized Americans with COPD. This difference may be attributed to the difference of the degree of clinical and subclinical ischemic degenerative changes of the heart. Autopsy findings and electrocardiograms of 4 cases with RVH were discussed.