Chest
Volume 115, Issue 6, June 1999, Pages 1742-1744
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Selected Reports
New ECG Changes Associated With a Tension Pneumothorax: A Case Report

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This case report reveals new ECG changes associated with a left tension pneumothorax, specifically, PR-segment elevation in the inferior leads and reciprocal PR-segment depression in the aVR lead. A mechanism of atrial injury and/or ischemia is proposed as the cause, and the ECG changes associated with a left tension pneumothorax are briefly reviewed.

Section snippets

Case Report

An 82-year-old woman presented with acute onset of shortness of breath and left-sided chest pain. Her medical history was significant for > 80 pack-years of smoking and GI bleeding from diverticulosis. On presentation to the emergency department, her BP was 140/80 mm Hg, with a pulse rate of 148 beats/min and a respiratory rate of 34 breaths/min. Her oxygen saturation, as measured by pulse oximetry, was 94%. On physical examination, she was in mild respiratory distress, she was without jugular

Discussion

Numerous mechanisms have been proposed whereby a tension pneumothorax may cause ECG changes. Simple displacement of the heart has been reported to cause only minor changes.2,3 Others have proposed that rotation around the posteroanterior or longitudinal axis causes shifts in the heart's axis as well as loss of anterior forces and precordial R waves.4,5 Air within the thoracic cavity has also been suggested as a cause of the ECG changes.6 Although both Lewis2 and Dieuaide et al3 have shown that

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  • Minimal pneumothorax with dynamic changes in ST segment similar to myocardial infarction

    2017, American Journal of Emergency Medicine
    Citation Excerpt :

    They reported that abnormal axis deviation is more common in the patient with left pneumothorax while QRS and T wave changes are seen more often in the patient with right pneumothorax. Other reported changes include QRS voltage variation, QS pattern, PR segment elevation, and S1Q3T3 pattern [5-7]. The assumed mechanism for changes in ECG findings is cardiac rotation around its long axis, right ventricular dilatation due to increased pulmonary artery pressure, and cardiac displacement [8-10].

  • Case report: An electrocardiogram of spontaneous pneumothorax mimicking arm lead reversal

    2014, Journal of Emergency Medicine
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    According to this second theory, the change in position of the heart is responsible for the changes seen on ECG. A variance on this theory was proposed by Strizik and Forman that in tension pneumothorax, in addition to the rotation of the heart, increased pressure in the chest could lead to areas of myocardial ischemia (12). Because the ECG presentation of our case mimics arm lead reversal, and is more similar to the findings of dextrocardia, we speculate that the mechanism that best explains this presentation is rotation and displacement of the heart, but this needs to be scientifically verified.

  • Transient ST-segment elevation resembling acute myocardial infarction in a patient with a right secondary spontaneous pneumothorax

    2013, Heart Lung and Circulation
    Citation Excerpt :

    Changes seen in left-sided pneumothorax are well described and include right axis deviation, QRS amplitude changes, diminution precordial R-wave voltage and T-wave inversions [2]. PR-segment elevation has also been reported [3]. Right-sided pneumothorax changes most commonly involve the QRS complex (particularly right bundle branch block) and T-wave inversion [1].

  • "Door-to-Chest-Tube" Time?

    2010, American Journal of Medicine
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