Electrocardiographic changes in young patients with spontaneous pneumothorax: A retrospective study.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
30 Jul 2021
30 Jul 2021
Historique:
received:
27
03
2021
accepted:
11
07
2021
entrez:
16
8
2021
pubmed:
17
8
2021
medline:
21
8
2021
Statut:
ppublish
Résumé
Primary spontaneous pneumothorax (PSP) commonly occurs in adolescents. PSP symptoms can mimic cardiac event. We aimed to examine electrocardiography (ECG) changes that accompanied PSP in relation to side and size of pneumothorax.A retrospectively reviewed 57 adolescents presented with PSP and underwent a cardiac evaluation.Overall, 49 patients (86%) were male, median age of 16 years. Of these, 1 patient had a known mitral valve prolapse. In 56 patients the initial episode of PSP was unilateral (16 left sided and 40 right sided), and 1 was bilateral. The main initial symptom was chest pain or dyspnea and chest pain 66.6% and 33.3% respectively. Small pneumothorax was right and left sided in 1and 8 patients respectively, medium right (n = 8) medium left (n = 22), large right (n = 7) and large left (n = 10). One additional patient had medium bilateral pneumothorax. ECG findings were abnormal in 12 patients (21%) and included ST elevation in 5 patients, inverted T wave in 2 patients, incomplete right bundle branch block in 2 patients, poor R wave progression, left axis deviation and low QRS voltage in 1 patient each. Only 2 patients had abnormal echocardiography findings, MPV (n = 1) and minimal mitral and tricuspid regurgitation (n = 1). Serum troponin-T levels were normal in all patients.ECG changes were found in 21% among pediatric patients with PSP. No correlation was observed between ECG changes and side/size of pneumothorax. It is important to rule out pneumothorax among children presented with chest pain, dyspnea and ECG changes.
Identifiants
pubmed: 34397732
doi: 10.1097/MD.0000000000026793
pii: 00005792-202107300-00053
pmc: PMC8322562
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e26793Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no funding and conflicts of interests to disclose.
Références
Grundy S, Bentley A, Tschopp JM. Primary spontaneous pneumothorax: a diffuse disease of the pleura. Respiration 2012;83:185–9.
Tschopp JM, Rami-Porta R, Noppen M, Astoul P. Management of spontaneous pneumothorax: state of the art. Eur Respir J 2006;28:637–50.
Copeland RB, Omenn GS. Electrocardiogram changes suggestive of coronary artery disease in pneumothorax. Their reversibility with upright posture. Arch Intern Med 1970;125:151–3.
Walston A, Brewer DL, Kitchens CS, Krook JE. The electrocardiographic manifestations of spontaneous left pneumothorax. Ann Intern Med 1974;80:375–9.
Kuritzky P, Goldfarb AL. Unusual electrocardiographic changes in spontaneous pneumothorax. Chest 1976;70:535–7.
Habibzadeh MA. ECG changes associated with spontaneous left-sided pneumothorax. Postgrad Med 1980;68:221–3. 226.
Diamond JR, Estes NM. ECG changes associated with iatrogenic left pneumothorax simulating anterior myocardial infarction. Am Heart J 1982;103:303–5.
Feldman T, January CT. ECG changes in pneumothorax. A unique finding and proposed mechanism. Chest 1984;86:143–5.
Keller N, Szaff M, Sykulski R. Electrocardiographic changes in spontaneous left pneumothorax. Acta Med Scand 1987;221:499–501.
Ruo W, Rupani G. Left tension pneumothorax mimicking myocardial ischemia after percutaneous central venous cannulation. Anesthesiology 1992;76:306–8.
Krenke R, Nasilowski J, Przybylowski T, Chazan R. Electrocardiographic changes in patients with spontaneous pneumothorax. J Physiol Pharmacol 2008;6:361–73.
Collins CD, Lopez A, Mathie A, Wood V, Jackson JE, Roddie ME. Quantification of pneumothorax size on chest radiographs using interpleural distances: regression analysis based on volume measurements from helical CT. AJR Am J Roentgenol 1995;165:1127–30.
Using the Pulse Oximeter. Tutorial 2 – Advanced. https://www.who.int/patientsafety/safesurgery/pulse_oximetry/who_ps_pulse_oxymetry_tutorial2_advanced_en.pdf?ua=1 . World health organization. 2011. Accessed October 2020.
Evans WN, Acherman RJ, Mayman GA, Rollins RC, Kip KT. Simplified pediatric electrocardiogram interpretation. Clin Pediatr (Phila) 2010;49:363–72.
Kounis NG, Mallioris CN, Karavias D, Zavras G, Siablis D. Unusual electrocardiographic changes in intrathoracic conditions. Acta Cardiol 1987;42:179–85.
Strizik B, Forman R. New ECG changes associated with a tension pneumothorax: a case report. Chest 1999;115:1742–4.
Raev D. A case of spontaneous left-sided pneumothorax with ECG changes resembling acute myocardial infarction. Int J Cardiol 1996;56:197–9.
Monterrubio Villar J, Fernández Bergés D, Alzugaray Fraga RJ, Veiga MD, Córdoba López A, Corcho Díaz G. ST elevation and tension pneumothorax. Rev Esp Cardiol 2000;53:467–70.
Slay RD, Slay LE, Luehrs JG. Transient ST elevation associated with tension pneumothorax. JACEP 1979;8:16–8.
Janssens U, Koch KC, Graf J, Hanrath P. Severe transmyocardial ischemia in a patient with tension pneumothorax. Crit Care Med 2000;28:1638–41.
Shiyovich A, Vladimir Z, Nesher L. Left spontaneous pneumothorax presenting with ST-segment elevations: a case report and review of the literature. Heart Lung 2011;40:88–91.
Rosjo H, Kravdal G, Hoeseth A, et al. Troponin I measured by high-sensitivity assay in patients with suspected reversible myocardial ischemia: data from the Akershus Cardiac Examination (ACE) 1 study. Clin Chem 2012;58:1565–73.
Lee W, Lee Y, Kim C, et al. Changes in electrocardiographic findings after closed thoracostomy in patients with spontaneous pneumothorax. Clin Exp Emerg Med 2017;4:38–47.
Ruhela M, Khandelwal G, Gupta S, Bansal A. Acute right bundle branch block due to pneumothorax. J Family Med Prim Care 2018;7:1126–8.
Lin GM, Huang SC, Li YH, Han CL. Electrocardiographic changes in young men with left-sided spontaneous pneumothorax. Int J Cardiol 2014;177:e9.
Badheka AO, Singh V, Patel NJ, et al. QRS duration on electrocardiography and cardiovascular mortality (from the national health and nutrition examination survey-III). Am J Cardiol 2013;112:671–7.
Soltani P, Malozzi CM, Abi Saleh B, Omar B. Electrocardiogram manifestation of spontaneous pneumothorax. Am J Emerg Med 2009;27:750.e1–5.
Price JW. Novel electrocardiographic changes associated with iatrogenic pneumothorax. Am J Crit Care 2006;15:415–9.