Electrocardiogram Manifestations in Traumatic Right-sided Pneumothorax: Case Report-Juniper Publishers


Abstract

This report describes a case of a patient with right-sided pneumothorax presenting with classic electrocardiographic findings such as low voltage, extreme axis deviation to the right and tall R-wave in V1 suggesting right-ventricle overload. Drainage and aspiration were performed stabilizing the patient.

Keywords: Pneumothorax; Right-sided pneumothorax; Electrocardiography

Introduction

Electrocardiogram (ECG) findings such as right axis deviation, QSR abnormalities, T-wave inversions and ST-segment alterations [1] may lead to misdiagnosis of pneumothorax [2]. We describe a case of pneumothorax presenting with changes in ECG.

Case Report

A 74-year-old male was admitted to the emergency department with chest pain 72 hours after a fall. The patient had a past medical history of hypertension, hyperlipidemia and smoking (5pack/year).

At admission, the patient was in antalgic position and with shortness of breath. Examination revealed blood pressure of 148/90mmHg, cardiac frequency of 66beats/min, oxygen saturation of 88% and decreased breath sounds at right hemi- thorax.



Admission X-ray and computed tomography showed fracture extreme axis deviation to the right and tall R-wave in V1 suggesting at the sixth, seventh and eighth right costal arches with significant right-ventricle overload (Figure 3). right pneumothorax (Figure 1 & 2). ECG showed low voltage,


Drainage and continuous aspiration were performed for 48 ECG, except for early repolarization on lateral leads (Figure 4). hours; discharge after 72 hours of hospitalization and normal ECG, except for early repolarization on lateral leads (Figure 4).


Discussion

The main ECG findings in pneumothorax cases include decreased QRS complex amplitude, QRS axis deviation, electrical alternans, reduced precordial R-wave voltage and precordial T-waves [3], being present in approximately 25% of the cases [1,2]. ST-segment deviations are also rare findings in patients with pneumothorax [2,4].

The potential mechanisms behind the ECG changes in patients with pneumothorax are: the cardiac rotation around its axis; right ventricular dilatation due to increased pulmonary artery pressure; cardiac displacement; and air in the thoracic cavity acting as an insulator [3,5].

Depending on the size, amount of tension and the side involved on pneumothorax, the magnitude of ECG changes can vary substantially [3]. In left-sided pneumothorax, the most common findings include abnormal axis deviation and T-wave inversion [2]. Right-sided often include reduced QRS voltage and QRS axis changes [3].

Krenke et al. [2] showed that in right-sided pneumothorax the QRS axis deviation is mainly to the right without exceeding 30o and the QRS amplitude in V5 and V6 leads is increased [2].However, in the case described, there is an extreme axis deviation to the right and decreased voltage in all leads, including V5-V6.

Conflict of Interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com/open-access.php

For more articles in Open Access Journal of Cardiology & Cardiovascular Therapy please click on: https://juniperpublishers.com/jocct/index.php

Comments

Post a Comment

Popular posts from this blog

Can We Prevent Cardio Vascular Morbidities and Mortalities?-Juniper Publishers

Image
JUNIPER PUBLISHERS - OPEN ACCESS JOURNAL OF CARDIOLOGY & CARDIOVASCULAR THERAPY   Opinion Cardivan- vascular dieses are group of disease which are totally preventable, it is concluded that almost 90% of CVD is avoidable. Improving risk factors is the key point in Prevention strategies, thus minimizing atherosclerosis process are significantly linked to improving risk factors by: healthy diet consumption, conducting exercises, eliminating tobacco smoke and educing alcohol intake. Lipids and high blood pressure management and control have great impact on CVD morbidities and mortalities. Applying effective strep throat with suitable antibiotics can contribute to decrease risk of rheumatic heart disease. Cardiovascular diseases kept the main cause of mortality worldwide globally. It has been estimated that the mortality rate has been increased from 17.9 million deaths (32.1%) in 2015, up from 12.3 million (25.8%) in 1990 and have been increasing in much of the developing w
Read more

Spinal Cord Injury: An Under Recognized Cardiovascular Disease Risk Factor-Juniper Publishers

Image
JUNIPER PUBLISHERS - OPEN ACCESS JOURNAL OF CARDIOLOGY & CARDIOVASCULAR THERAPY Keywords Keywords: Stroke; Coronary artery disease; Paraplegia; Tetraplegia Opinion Spinal cord injury (SCI) is a devastating, life-changing condition causing paralysis and sensory impairment as well as autonomic dysfunction. In addition, evidence documents a state of chronic inflammation in individuals with SCI [ 1 - 4 ]. Importantly, chronic inflammation is a significant cardiovascular disease risk factor. Furthermore, paralysis can lead to a relatively sedentary life style and a consequent reduction in physical work capacity [ 58 ]. Other consequences of inactivity are a higher body weight, a higher percentage of body fat [ 9 , 10 ], skeletal muscle dysfunction [ 11 - 14 ] and a lower forced vital capacity [ 15 - 17 ]. Autonomic dysfunction involves an abnormal and unstable regulation of the of the heart and vasculature [ 18 ].
Read more

Sudden Heart Pathology-a New Research Hipotesys-Juniper Publishers

Image
JUNIPER PUBLISHERS - OPEN ACCESS JOURNAL OF CARDIOLOGY & CARDIOVASCULAR THERAPY   Keywords Keywords: Cardiology; Heart disease; Diagnostic systems Introduction We can see that heart is usually studied using many diagnostic strategies and under different Mechanism as functions, electric activity, receptorial, imaging, instrumental test, genetic profile, exercise tests, biopsy and so on. But what we can see is that until today in not possible to prevent some unexpected death. So we can think that perhaps we need more diagnostic test to right consider this aspect. Can we use innovative methods to introduce more useful systems? In ischemic condition some test can help to detect the residual heart capacity but can we test in the same way the heart biochemical-metabolic status or pharmacological profile? In a recent case we have see that in a transplant heart procedure was used an organ by a patient death Due to cerebral damage after a heart at
Read more