70-year-old woman with dyspnea. What diagnosis belongs on her problem list?
This is an excellent example of EKG changes of COPD.
Findings suggestive of COPD include (but you don’t need to have all):
- P waves >0.25 mV in II, III, or aVF (P “pulmonale”)
- Lead I sign – isoelectric P wave, QRS amplitude <0.15 mV, and T wave <0.05mV in lead I
- QRS amplitude in all limb leads <0.5 mV
- QRS axis > 90° (right axis deviation)
Just in case you’re still not a believer, here’s her CXR…
Note the impressive changes of emphysema: flat and depressed diaphragms and the “vertical” heart.