Study of cardiovascular changes in COPD by ECG & 2D echo and correlation with duration and severity of COPD
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2016, Vol 4, Issue 12
Abstract
Chronic Obstructive Pulmonary Disease (COPD), a common preventable and treatable disease, is characterized by persistent, progressive airflow limitation. Beside lung involvement in COPD, cardiovascular disease is undoubtedly the most significant non respiratory contributor to both morbidity and mortality in these patients. The aim of our study was to study cardiac changes in COPD patients by electrocardiographic and echocardiographic evaluation and correlate the findings with severity and duration of the disease. This was a cross sectional study conducted in 62 patients. Patients more than 40 years with history suggestive of COPD were selected at random. The diagnosis of COPD was made by symptoms, and confirmed by physical examination, CXR-PA and Spirometry. Electrocardiography and Echocardiography was performed for all the patients.Among 62 COPD patients studied, 9 had enlarged pulmonary artery and 8had cardiomegaly on CXR. 29.03% (18/62) had signs of corpulmonale in this study. Signs of corpulmonale were present in most of the very severe group i.e, 88.2% (15/17) of COPD patients. Pedal edema was the most common sign of failure observed in 29.03% of COPD patients. 20.96% had loud second heart sound, 17.74% had rised JVP, 14.51% had tender hepatomegaly and12.90% had palpable P2.Out of the 62 COPD patients studied, 41(66.12%) had electrocardiographic changes. The most common electrocardiographic finding was p Pulmonale (32.25%) seen in most of the very severe group of COPD. The next common finding was R/S in V1>1 found in 20.96% and R/S in V6<1in 19.35%. Right axis deviation alone is found in 12.90%. 8.06% had RBBB, a finding found in severe and very severe groups of COPD in the present study. p values were calculated using fissure t test with 2x3 contingency table. All the ECG changes except right axis deviation and RBBB had significant relation with the severity of the disease. The insignificance for RAD and RBBB may be attributed to small sample size of the study. 44(70.96%) patients had 2D ECHO findings. The most common echocardiographic finding in the study was pulmonary artery hypertention observed in 56.45% followed by right atrial dilatation and right ventricular dilatation seen in 48.38% & 46.77% respectively. Right ventricular hypertrophy was found in 35.48% and inter ventricular septal wall motion abnormality is found in 17.74%.11.29% had left ventricular hypertrophy. 6.45% of the cases had left ventricular diastolic dysfunction.45.16% of the cases had tricuspid regurgitation. The findings of pulmonary arterial hypertention, right ventricular dilatation, right atrial dilatation, right ventricular hypertrophy and interventricular wall motion abnormality are found to have increased incidence with duration and severity of illness and found mostly in severe(stage-3 GOLD) and very severe(stage-4 GOLD) classes of COPD. The p values for 2D ECHO were calculated using Fissure t test. All the findings except LVH and LVDD had highly significant correlation with the severity and duration of the disease. To conclude, there is significant involvement of cardiovascular system in COPD patients. The electrocardiographic and echocardiographic findings had linear relation with the severity and duration of the disease. It is mandatory to investigate all the COPD patients with ECG and 2D ECHO as it aids in early detection and treatment of cardiac complications. Keywords:COPD,Spirometry, PAH,Corpulmonale, ECG, 2D ECHO.
Authors and Affiliations
Dr. V. Venkateswara Rao, Dr. Eswaramma
Keywords
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