Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 8

Optimal electrocardiographic limb lead set for rapid emphysema screening

Authors Bajaj R, Chhabra L, Basheer Z, Spodick DH

Received 5 September 2012

Accepted for publication 21 December 2012

Published 19 January 2013 Volume 2013:8 Pages 41—44

DOI https://doi.org/10.2147/COPD.S37776

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Rishi Bajaj,1 Lovely Chhabra,1 Zainab Basheer,2 David H Spodick3

1Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA; 2Department of Medicine, Al Ameen Medical College, Karnataka, India; 3Department of Cardiovascular Medicine, Saint Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA

Background: Pulmonary emphysema of any etiology has been shown to be strongly and quasidiagnostically associated with a vertical frontal P wave axis. A vertical P wave axis (>60 degrees) during sinus rhythm can be easily determined by a P wave in lead III greater than the P wave in lead I (bipolar lead set) or a dominantly negative P wave in aVL (unipolar lead set). The purpose of this investigation was to determine which set of limb leads may be better for identifying the vertical P vector of emphysema in adults.
Methods: Unselected consecutive electrocardiograms from 100 patients with a diagnosis of emphysema were analyzed to determine the P wave axis. Patients aged younger than 45 years, those not in sinus rhythm, and those with poor quality tracings were excluded. The electrocardiographic data were divided into three categories depending on the frontal P wave axis, ie, >60 degrees, 60 degrees, or <60 degrees, by each criterion (P amplitude lead III > lead I and a negative P wave in aVL).
Results: Sixty-six percent of patients had a P wave axis > 60 degrees based on aVL, and 88% of patients had a P wave axis > 60 degrees based on the P wave in lead III being greater than in lead I.
Conclusion: A P wave in lead III greater than that in lead I is a more sensitive marker than a negative P wave in aVL for diagnosing emphysema and is recommended for rapid routine screening.

Keywords: electrocardiography, P wave axis, emphysema

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Other articles by this author:

Diagnostic electrocardiographic dyad criteria of emphysema in left ventricular hypertrophy

Lanjewar SS, Chhabra L, Chaubey VK, Joshi S, Kulkarni G, Kothagundla C, Kaul S, Spodick DH

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:591-594

Published Date: 22 November 2013

P-wave indices in patients with pulmonary emphysema: do P-terminal force and interatrial block have confounding effects?

Chhabra L, Chaubey VK, Kothagundla C, Bajaj R, Kaul S, Spodick DH

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:245-250

Published Date: 14 May 2013

Readers of this article also read:

Use of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study

McCarthy C, Brennan JR, Brown L, Donaghy D, Jones P, Whelan R, McCormack N, Callanan I, Ryan J, McDonnell TJ

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:605-611

Published Date: 28 November 2013

The health care burden of high grade chronic obstructive pulmonary disease in Korea: analysis of the Korean Health Insurance Review and Assessment Service data

Kim JH, Rhee CK, Yoo KH, Kim YS, Lee SW, Park YB, Lee JH, Oh YM, Lee SD, Kim Y, Kim KJ, Yoon HK

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:561-568

Published Date: 19 November 2013

Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial

Dias FD, Sampaio LMM, da Silva GA, Dantas Gomes ELF, Nascimento ESP, Santos Alves VL, Stirbulov R, Costa D

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:537-544

Published Date: 5 November 2013

The development and pilot testing of the Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD)

Apps LD, Mitchell KE, Harrison SL, Sewell L, Williams JE, Young HML, Steiner M, Morgan M, Singh SJ

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:317-327

Published Date: 9 July 2013

The association between COPD and heart failure risk: a review

de Miguel Díez J, Chancafe Morgan J, Jiménez García R

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:305-312

Published Date: 28 June 2013

A comparison of three multidimensional indices of COPD severity as predictors of future exacerbations

Motegi T, Jones RC, Ishii T, Hattori K, Kusunoki Y, Furutate R, Yamada K, Gemma A, Kida K

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:259-271

Published Date: 31 May 2013

P-wave indices in patients with pulmonary emphysema: do P-terminal force and interatrial block have confounding effects?

Chhabra L, Chaubey VK, Kothagundla C, Bajaj R, Kaul S, Spodick DH

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:245-250

Published Date: 14 May 2013