Electrocardiographic Patterns in Pneumothorax

¹ The Department of Medicine, Veterans Administration Hospital, Butler, Pennsylvania.

1) Forty-five cases have been presented; forty-four with pneumothorax of one or the other side, and one with artificial pneumopericardium, with serial electrocardiographic studies before and after the initiation of pneumothorax or pneumopericardium.

2) Characteristic ECG patterns both in night and left sided pneumothorax have been shown and described.

3) A marked and definite difference in these ECG patterns between the right and left sided groups has been shown and illustrated.

4) The ECG pattern in the right sided group has been mainly a tendency to right axis shift, depression of QRS-1, and depression of P waves in the limb leads. T inversion has been notably absent.

5) The ECG pattern in the left sided group has been more conspicuous and more striking, and has consisted of a lower voltage of QRS-1, flattening of T waves in Lead 1, a change in the contour of QRS complexes in the chest leads, and a definite inversion of T waves in the chest leads; these T wave inversions being the most constant and conspicuous of all changes.

6) The T wave inversions have persisted in various other positions than supine, namely, standing, right lateral and prone.

7) As for the basic cause effecting these changes, the evidence is not conclusive. However, available evidence points to rotation of the heart and the presence of air between the heart and the chest wall as very probable causative factors.