Axis Illusion in Emphysema
Report:
Sinus tachycardia 110/min
Right atrial abnormality
P axis +85o
Left axis deviation
QRS –90o
Late (or no) transition
Comment:
An immediate clue that the LAD is not due to an LAHB (its commonest cause, overall) is that S2 > S3, opposite of what happens in the hemiblock. It is thought that the LAD here is due to cardiac position in a hyperinflated chest rather than a true change of the cardiac vector28 – hence the “illusion”.
The trace as a whole is virtually diagnostic of emphysema: classical P pulmonale, P axis almost +90o, narrow QRS (0.07”), marked clockwise rotation (late transition) and the LAD configuration itself.
Incidentally, P wave axis over +70o is the earliest ECG sign of emphysema29.
The patient returned to Casualty a month later (Fig 20a) in marked respiratory distress (she was a “pink puffer” rather than “blue bloater”). Her P pulmonale – I find it quite difficult to relinquish the term – was even more prominent. Some of it may be due to tachycardia itself.
If you have any suggestions for or feedback on this report, please let us know.
Hi, can we chat about some terms and conditions?
The library and it's records are licensed under the Creative Commons Attribution 4.0 International license.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
By clicking agree below, you are agreeing to adhere to CC BY 4.0.