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New ECG Changes Associated With a Tension Pneumothorax*
A Case Report
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.
(CHEST 1999; 115:1742-1744)
Key words: atrial injury; atrial ischemia; ECG; PR segment; tension pneumothorax
The ECG manifestations of a tension pneumothorax have been well described. For a left tension pneumothorax, these include a rightward shift of the mean frontal QRS axis, reduced precordial R-wave voltage, decreased and/or alternating QRS amplitude (electrical alternans), or precordial T-wave inversions.' Commonly, two or three of the above are present, and less often, all four are present. We present a case of ECG manifestations that have not been reported before (to our knowledge), such as PRsegment elevation and depression associated with a left tension pneumothorax. These ECG changes were transient, and they promptly reverted to the baseline on relief of the tension.
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 venous distention, and she had diminished breath sounds in both lung fields. An ECG revealed atrial fibrillation with a ventricular response of 150 beats/min. She was placed on aI regimen of 100% oxygen with the use of a face mask and...