EKG Interpretation: Dr. Le’s EKG from the CCU

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68 year old male with h/o chronic tobacco use c/o dyspnea x 2 days. Based on the history how would you interpret the EKG?



  • sannman

    Sinus tachycardia at 100, peaked and large P wave in II suggestive of R atrial enlargement, RSR pattern in V1-V2, poor R wave progression(?). I would go with changes suggestive of COPD, R sided pressure overload.

  • Enter Sannman with the answer.

    Looks like he has p-pulmonale. This is a CCU or MICU patient, so I’m guessing he ended up in the ICU setting with a problem with volume status that needed to be controlled. We don’t have vitals yet, but maybe he needed volume re-distribution with Nitro, BIPAP ventilator support, and might have been sick enough to need some inotropes?

    Tell us more.

  • ejacobiem

    Dr. Le’s Response:

    The EKG findings are consistent with P Pulmonale and can be seen with (but not pathognomonic for) COPD. The P Pulmonale EKG pattern consists of:

    1) peaked P waves and vertical P wave axis, which is consistent with right atrial overload secondary to pulmonary hypertension
    2) vertical to rightward QRS axis and slow precordial R wave progression due in part to hyperinflation and inferior displacement and rotation of the heart
    3) low (relatively) limb lead voltage secondary to hyperinflation and increased space between the heart and chest wall

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