FREQUENCY OF ECG ABNORMALITIES IN PATIENTS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ACCORDING TO DISEASE SEVERITY

ECG Abnormalities in Chronic Obstructive Pulmonary Disease

Abstract

Objective: The objective of this study was to find out the frequency of ECG abnormalities in patients of COPD in relation to disease severity.
Study Design: Cross Sectional study.
Place and Duration of Study: This study was carried out at the Department of Medicine, Military Hospital Rawalpindi, from Oct 2011 to Jun 2012.
Material and Methods: All patients presenting to the Department of Medicine both inpatient and outpatient, with diagnosis of COPD were included in the study. Patients with cardiac comorbidities were excluded. Also, patients on diuretics and long term oxygen therapy were excluded. A total of three hundred and forty three patients (343) were included in the study. Spirometry of all these patients was done to determine the FEV1 and FVC in order to classify the grade of severity of COPD. Standard 12 lead ECG of all these patients was done to find out the various ECG abnormalities.
Results: About 77 (22.5%) patients had mild COPD, while moderate COPD was seen in 121 (35.3%). Severe COPD was seen in 100 (29.2%) patients and very severe COPD was seen in 45 (13.1%) patients. The most common ECG abnormalities noted was right atrial enlargement (RAE) in 6 (7.8%) patients of mild COPD, 27 (22.3%) patients of moderate, 48 (48%) patients of severe and 24 (53.3%) patients of very severe COPD. Right ventricular hypertrophy (RVH) in 1 (1.3%) patient of mild, 7 (5.8%) patients of moderate, 19 (19%) patients of severe and 12 (26.7%) patients of very severe COPD. Sinus tachycardia was present in 6 (7.8%) patients of mild, 17 (14%) patients of moderate, 19 (19%) patients of severe and 10 (22.2%) patients of very severe COPD. Right bundle branch block (RBBB) was seen in 5 (6.5%) patients of mild, 9 (7.4%) patients of moderate, 13 (13%) patients of severe and 9 (20%) patients of very severe COPD. SVT was present in 1 (1.3%) patient of mild, 6 (5%) patients of moderate, 10 (10%) patients of severe and 8 (17%) patients of very severe COPD. Low voltage ECG was seen in 3
(3.9%) patients of mild, 7 (5.8%) patients of moderate, 12 (12%) patients of severe and 6  13.3%) patients of very severe COPD. Atrial premature contractions (APCs) were present in 3 (3.9%) patients of mild, 11 (9.1%) patients of moderate, 14 (14%) patients of severe and 6 (13.3%) patients of very severe COPD. Normal ECG was seen in 54 (70.1%) patients of mild, 52 (43%) patients of moderate, 14 (14%) patients of severe and 3 (6.7%) patients of very severe COPD.
Conclusion: A number of ECG abnormalities were seen in patients with COPD. They were more frequent with increased grade of severity of COPD. Therefore, it is recommended that ECG should be done routinely in patients with COPD.