Electrocardiogram Manifestations in Traumatic Right-sided Pneumothorax: Case Report
Eduardo Lapa Santos1*, Eduardo Alberto de Castro Roque2, Bianca Dadalto2, Luca T Dompieri3, Maria Amellia Aquino3 and Renato D Lopes4
1Cardiology Unit, Hospital das Clinicas, Universidade Federal do Pernambuco, Brazil
2Hospital Metropolitano, Brazil
3Universidade Federal de Pernambuco, Brazil
4Division of Cardiology, Duke University Medical Center, USA
Submission: March 10, 2018; Published: May 09, 2018
*Corresponding author: Eduardo Lapa Santos, Cardiology Unit, Hospital das Clinicas, Universidade Federal do Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitaria, Recife -PE, 50670-901, Brazil, Tel: +55 81 996864444; Email: eduardolapa@gmail.com
How to cite this article: Eduardo Lapa Santos, Eduardo Alberto de Castro Roque, Bianca Dadalto, Luca T Dompieri, et al. Electrocardiogram Manifestations in Traumatic Right-sided Pneumothorax: Case Report. J Cardiol & Cardiovasc Ther. 2018; 10(3): 555789. DOI: 10.19080/JOCCT.2018.10.555789
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.
![Click here to view Large Figure 1](images/JOCCT.MS.ID.555789.G001.png)
![Click here to view Large Figure 2](images/JOCCT.MS.ID.555789.G002.png)
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,
![Click here to view Large Figure 3](images/JOCCT.MS.ID.555789.G003.png)
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).
![Click here to view Large Figure 4](images/JOCCT.MS.ID.555789.G004.png)
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.
References
- Alzghoul B, Innabi A, Shanbhag A, Chatterjee K, Amer F, et al. (2017) Iatrogenic right-sided pneumothorax presenting as ST-segment elevation: a rare case report and review of literature. Case Reports Crit Care 2017: 3291751.
- Krenke R, Nasilowski J, Przybylowski T, Chazan R (2008) Electrocardiographic changes in patients with spontaneous pneumothorax. J Physiol Pharmacol 59(Suppl 6): 361-373.
- Pollack ML (2006) ECG manifestations of selected extracardiac diseases. Emerg Med Clin North Am 24(1): 133-143.
- Shiyovich A, Vladimir Z, Nesher L (2011) Left spontaneous pneumothorax presenting with ST-segment elevations: a case report and review of the literature. Hear Lung 40(1): 88-91.
- Yeom SR, Park SW, Kim YD, Ahn BJ, Ahn JH, et al. (2017) Minimal pneumothorax with dynamic changes in ST segment similar to myocardial infarction. Am J Emerg Med 35(8): 1210.e1-1210.e4.