Electrocardiographic changes in Emphysema

Table 1 Common electrocardiographic changes commonly related to chronic obstructive pulmonary disease/emphysema

Vertical P-wave	P-wave axis > 60°
P-pulmonale	P-amplitude in II, III or aVF ≥ 2.5 mm
	P-amplitude in V1 ≥ 1.5 mm
Right ventricular hypertrophy	R in V1 ≥ 7 mm
	R/S in V1 > 1
	VAT in V1 > 35 ms
Sokolow-Lyon: Right ventricular hypertrophy	R in V1 + S in V5 or V6 > 10.5 mm
Clockwise rotation	R/S ratio in V5 ≤ 1
Low voltage limb leads	QRS (R+S) < 5 mm in I, II, aVF, III (all)
Low voltage precordial leads	QRS < 10 mV in V1–V6 (all)
S1S2S3 pattern	Dominant S in I, II, III (all)1
QS complex	Lead III
Rightward QRS-axis deviation:	> 90°
Short QRS duration	< 75 ms
Elevated resting heart rate (especially during exacerbation)	HR > 80 beats/min