P-Pulmonale in the Precordial Leads and A Review of the Mutability of the P-Waves in Chronic Cor Pulmonale

¹ Veterans Administration, Castle Point, N. Y.

In marked right atrial enlargement due to thrombosis of the pulmonary arteries there were observed not only peaked P-Waves in leads two and three but also in the precordial leads V-2 and V-3 where the amplitude reached 0.4 millivolts.

In severe cor pulmonale resulting from pulmonary tuberculosis there were noticed, in addition to a high peaked P-Wave in lead two, serial changes in leads V-2 and V-3 with an increase in the P-Waves to 0.3 millivolts in these two leads.

In the absence of other causes the tall peaked P-Wave in the precordial leads over the right side of the heart may serve as a confirmatory sign of severe cor pulmonale.

The variability in shape, size and direction of the P-pulmonale during protracted illness is demonstrated in a more common case, namely chronic cor pulmonale due to pulmonary emphysema.