Evaluations of vertical P‐wave axis in the diagnosis of


Background: Emphysema is chronic obstructive pulmonary disease thatresult in an abnormal permanent enlargement of air spaces distal to theterminal bronchioles. This leads to presence of increased air between theheart and the ECG recording electrodes that may alter ECG findings inpatient with emphysema.Aims: To evaluate the vertical P‐wave axis in the diagnosis of emphysemaand assessment of its severity.Patients and Methods: This is a case ‐ control study conducted at AlYarmouk Teaching Hospital and The Medical City in Baghdad during theperiod from the 1 st of February 2012 to 31 st of January 2013. A total of 100emphysematous patients compared with other well matched 100 nonemphysematous patients as a control group.The diagnosis of pulmonary emphysema was based on clinical history ,physical examination , chest radiographs finding, High resolution chest CTscan and pulmonary function test. Full history including age, sex,occupation, history of smoking was taken and complete physicalexamination was done on both groups, ECG and PFT done for allemphysema patient and control group and P‐wave axis calculated.Results: Demographic characteristics of emphysema patients & nonemphysema controls were comparable apart from significant associationbetween smoking and emphysema (P < 0.001). Our emphysematouspatients show that mean P‐wave axis were significantly (P < 0.01) higherthan that of control group. There is 86% of emphysema patient withvertical (>60 °) P‐wave axis in comparison to 9% of control group.There isa significant inverse correlation between P wave axis and FEV1 thatdecrease in FEV1 is associated with increase in P wave axis and vice versa.Those with FEV1 less than 50% significantly have higher P wave axis meanConclusions: This study revealed clearly that p‐wave axis deviation to theright is the most characteristic ECG change that occur in emphysema.Moreover, There is a significant inverse correlation between P wave axisand FEV1.