P wave axis and its correlation with severity of chronic obstructive pulmonary disease


  • Prasuna K. R. Department of General Medicine, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu, India
  • Praveena Korani Ratnam Department of General Medicine, Sir Ronald Ross Institute of Tropical and Communicable Diseases, Nallakunta, Hyderabad, Telangana, India
  • Pramod Kumar K. R. Department of General Medicine, Deccan College of Medical Sciences, Hyderabad, Telangana, India
  • Krishna Kumar T. V. K. Department of General Medicine, Government Medical College, Nizamabad, Telangana, India




Cardiac, Correlation, Electrocardiogram, Effects, ECHO, P wave, Severity


Background: COPD can affect the heart as secondary effects of the disease. The electrocardiography has been seen as a very best tool for early diagnosis of any cardiac changes that may occur as a result of secondary effects of the chronic obstructive pulmonary disease. Objective of the study was to study the P wave axis and its correlation with severity of COPD.

Methods: Here, 30 Patients of COPD confirmed by clinical history, examination and Pulmonary function tests were included in the study. These patients were clinically examined, and they underwent routine investigations like hemogram, urine examination, blood urea, serum creatinine, chest x-ray, random blood sugar, sputum examination and ABG analysis. These patients underwent pulmonary function test, ECG and ECHO.

Results: In this study 36.66% of patients had RVH. Incomplete RBBB was seen in 20%. 13.33% had normal ECG. Most common finding in patients with less than one year of exposure was RVH. Low voltage complexes and R/S ratio in V1>1 were the only ECG changes with significant correlation with severity of the disease (p<0.05).  Maximum no. of patients had a P wave axis of 71-800. the correlation between P wave axis and the duration of the disease was found to be statistically significant. the correlation between P wave axis and the severity of the disease was found to be statistically significant, 8/27 patients (29.63%) with less than one year of disease had features of corpulmonale.

Conclusions: P-axis verticalization can serve as a very effective electrocardiographic screening tool for emphysema in the general population.


Global Initiative for Chronic Obstructive Lung Disease - Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary disease. Available at: http.//www.goldcopd.com. Accessed 27 November 2013.

Murray CJ, Lopez AD. Evidence based health policy-lessons from global burden of disease study. Sci. 1996;274:740-3.

Gupta NK, Agarwal RK, Srivastav AB, Ved ML. Echocardiographic evaluation of heart in chronic obstructive pulmonary disease patient and its correlation with severity of disease. Lung Ind. 2011:105-9.

Shah NS, Koller SM, Janover ML, Spodick DH. Diaphragm levels as determinants of P axis in restrictive vs. obstructive pulmonary disease. Chest. 1995;107:697-700.

Thomas AJ, Aplyasawat S, Spodick DH. Electrocardiographic detection of emphysema. Am J Cardiol. 2011;107:1090-2.

Weitzenblum E. Chronic Cor Pulmonale. Heart. 2003;89:225-30.

Phillips JH, Burch GE. Problems in the diagnosis of cor pulmonale. Am Heart J. 1963;6(6):818-32.

Rachaiah NM, Rachaiah JM, Krishnaswamy RB. A correlative study of spirometric parameters and ECG changes in patients with chronic obstructive pulmonary disease. Int J Biol Med Res. 2012;3(1):1322-6.

Agarwal RL, Kumar D, Gurpreet, Agarwal DK, Chabra GS. Diagnostic values of electrocardiogram in chronic obstructive pulmonary disease. Lung Ind. 2008:78-81.

Spodick DH, Hauger - Kelvene JH, Tyler JM, Muesch H, Dorr CA. The electrocardiogram in pulmonary emphysema. Relationship of characteristic electrocardiographic findings to severity of disease as measured by degree of airway obstruction. Am Rev Resp Dis. 1963;88:14.

Holtzman D, Aronow WS, Mellana WM, Sharma M, Mehta N, Lim J, et al. Electrocardiographic abnormalities in patients with severe versus mild or moderate chronic obstructive pulmonary disease followed in an academic outpatient pulmonary clinic. Annal Non-invasi Electr Cardiol. 2011;16(1):30-2.

Chhabra L, Sareen P, Perli D, Srinivasan I, Spodick DH. Vertical P-wave axis: the electrocardiographic synonym for pulmonary emphysema and its severity. Ind Heart J. 2012 Jan-Feb;64(1):40-2.

Boussuges A, Pinet C, Molenat F, Burnet H, Ambrosi P, Badier M, et al. Left atrial and ventricular filling in chronic obstructive pulmonary disease. An echocardiographic and Doppler study. Am J Respir Crit Care Med. 2000;162:670-5.

Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJV. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail. 2009;11:130-9.

Ikeda K, Kubota I, Takahashi K, Yasui S. P wave changes in obstructive and restrictive lung diseases. J. Electrocardiol. 1985;18:233-8.

Himelmann RB, Struve SN, Brown JK, Namnum P, Schiller NB. Improved recognition of cor pulmonale in patients with severe chronic obstructive pulmonary disease. Am J Med. 1988;84:891-8.






Original Research Articles