Cor Pulmonale: COAD

Report:

Sinus tachycardia

Right atrial abnormality

Left atrial abnormality

Right axis deviation +130o

Possible left ventricular hypertrophy

Nonspecific ST/T changes

Comment:

There is an obvious right axis and a P pulmonale with a right axis of its own (+85o). P wave axis shift beyond +70o is the earliest ECG sign of emphysema.

LVH often coexists with cor pulmonale, for a variety of reasons. It is suggested here by RV6 > RV5 and the lack of (expected) clockwise rotation; further, T waves are inverted in V5-6, beyond where RV ‘strain’ would be manifest. Finally, the LAA (increased V1 PTF) may in fact be left atrial enlargement, rather than right atrial enlargement, as sometimes happens.

The embryonic R waves in V1 have no clinical significance beyond expressing that lead’s potential to manifest RSR’ pattern in future.

Below (Fig 179a) is another cor pulmonale RVH, from a 31 year old man who had the original, malignant form of fibrosing alveolitis described by Hamman and Rich.

The QRS duration is only 0.8”, with a needle-thin S waves in 1 or V6. Thus the dominant R wave in V1 is more likely an expression of RVH than of incomplete RBBB. Other evidence for RVH includes the RAD, RAA and T inversion in inferior and septal leads.