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Arsh H, Iyer N, Ahmed M, Kumari V, Khan UN, Khatri CP, Payal FNU, Kumar S, Hayat MT, Kumar D, Rani D, Partab FNU, Keswani S, Mehmoodi A, Malik J. Electrocardiographic changes in pneumothorax: an updated review. Ann Med Surg (Lond) 2024; 86:3551-3556. [PMID: 38846885 PMCID: PMC11152795 DOI: 10.1097/ms9.0000000000002080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/09/2024] [Indexed: 06/09/2024] Open
Abstract
ECG changes in pneumothorax have gained recognition as important indicators of cardiopulmonary interactions. This narrative review examines the existing literature to provide insights into the various ECG abnormalities observed in patients with pneumothorax, their underlying mechanisms, and clinical implications. The review highlights the commonly reported changes, including alterations in the electrical axis, ST segment deviations, T-wave abnormalities, and arrhythmias. The rightward shift of the electrical axis is attributed to cardiac displacement caused by increased intrathoracic pressure. ST segment deviations may reflect the influence of altered intrathoracic pressure on myocardial oxygen supply and demand. T-wave abnormalities may result from altered myocardial repolarization and hypoxemia. Arrhythmias, although varying in incidence and type, have been associated with pneumothorax. The clinical implications of these ECG changes are discussed, emphasizing their role in diagnosis, risk stratification, treatment optimization, and prognostication. Additionally, future research directions are outlined, including prospective studies, mechanistic investigations, and the integration of artificial intelligence. Enhancing our understanding of ECG changes in pneumothorax can lead to improved patient care, better management strategies, and the development of evidence-based guidelines. The objective of this review is to demonstrate the presence of various ECG abnormalities in patients with pneumothorax.
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Affiliation(s)
- Hina Arsh
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Nandhini Iyer
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Muteen Ahmed
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Versha Kumari
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Umaima N. Khan
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Chander P. Khatri
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - FNU Payal
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Sameet Kumar
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Muhammad T. Hayat
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Deepak Kumar
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Deepa Rani
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - FNU Partab
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Shiwani Keswani
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
| | - Amin Mehmoodi
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
- Department of Medicine, Ibn e Seena Hospital, Kabul, Afghanistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group
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A deep learning-based system capable of detecting pneumothorax via electrocardiogram. Eur J Trauma Emerg Surg 2022; 48:3317-3326. [PMID: 35166869 DOI: 10.1007/s00068-022-01904-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine if an electrocardiogram-based artificial intelligence system can identify pneumothorax prior to radiological examination. METHODS This is a single-center, retrospective, electrocardiogram-based artificial intelligence (AI) system study that included 107 ECGs from 98 pneumothorax patients. Seven patients received needle decompression due to tension pneumothorax, and the others received thoracostomy due to instability (respiratory rate ≥ 24 breaths/min; heart rate, < 60 beats/min or > 120 beats/min; hypotension; room air O2 saturation, < 90%; and patient could not speak in whole sentences between breaths). Traumatic pneumothorax and bilateral pneumothorax were excluded. The ECGs of 132,127 patients presenting to the emergency department without pneumothorax were used as the control group. The development cohort included approximately 80% of the ECGs for training the deep learning model (DLM), and the other 20% of ECGs were used to validate the performance. A human-machine competition involving three physicians was conducted to assess the model performance. RESULTS The areas under the receiver operating characteristic (ROC) curves (AUCs) of the DLM in the validation cohort and competition set were 0.947 and 0.957, respectively. The sensitivity and specificity of our DLM were 94.7% and 88.1% in the validation cohort, respectively, which were significantly higher than those of all physicians. Our DLM could also recognize the location of pneumothorax with 100% accuracy. Lead-specific analysis showed that lead I ECG made a major contribution, achieving an AUC of 0.930 (94.7% sensitivity, 86.0% specificity). The inclusion of the patient characteristics allowed our AI system to achieve an AUC of 0.994. CONCLUSION The present AI system may assist the medical system in the early identification of pneumothorax through 12-lead ECG, and it performs as well with lead I ECG alone as with 12-lead ECG.
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Yeom SR, Park SW, Kim YD, Ahn BJ, Ahn JH, Wang IJ. Minimal pneumothorax with dynamic changes in ST segment similar to myocardial infarction. Am J Emerg Med 2017; 35:1210.e1-1210.e4. [PMID: 28438445 DOI: 10.1016/j.ajem.2017.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 11/26/2022] Open
Abstract
Pneumothorax can cause a variety of electrocardiographic changes. ST segment elevation, which is mainly observed in myocardial infarction, can also be induced by pneumothorax. The mechanism is presumed to be a decrease in cardiac output, due to increased intra-thoracic pressure. We encountered a patient with ST segment elevation with minimal pneumothorax. Coronary angiography with ergonovine provocation test and echocardiogram had normal findings. The ST segment elevation was normalized by decreasing the amount of pneumothorax. We reviewed the literature and present possible mechanisms for this condition.
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Affiliation(s)
- Seok-Ran Yeom
- Pusan National University Hospital, Department of Emergency Medicine, 179, Gudeok-ro, Seo-gu, Busan 602-739, South Korea
| | - Sung-Wook Park
- Pusan National University Hospital, Department of Emergency Medicine, 179, Gudeok-ro, Seo-gu, Busan 602-739, South Korea
| | - Young-Dae Kim
- Pusan National University Hospital, Department of Thoracic and Cardiovascular Surgery, Pusan National University of College of Medicine, 179, Gudeok-ro, Seo-gu, Busan 602-739, South Korea.
| | - Byung-Jae Ahn
- Pusan National University Hospital, Department of Internal Medicine, 179, Gudeok-ro, Seo-gu, Busan 602-739, South Korea
| | - Jin-Hee Ahn
- Pusan National University Hospital, Department of Cardiology, 179, Gudeok-ro, Seo-gu, Busan 602-739, South Korea
| | - Il-Jae Wang
- Pusan National University Hospital, Department of Emergency Medicine, 179, Gudeok-ro, Seo-gu, Busan 602-739, South Korea.
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Lee W, Lee Y, Kim C, Choi HJ, Kang B, Lim TH, Oh J, Kang H, Shin J. Changes in electrocardiographic findings after closed thoracostomy in patients with spontaneous pneumothorax. Clin Exp Emerg Med 2017; 4:38-47. [PMID: 28435901 PMCID: PMC5385512 DOI: 10.15441/ceem.16.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/26/2016] [Accepted: 12/02/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We aimed to describe electrocardiographic (ECG) findings in spontaneous pneumothorax patients before and after closed thoracostomy. METHODS This is a retrospective study which included patients with spontaneous pneumothorax who presented to an emergency department of a tertiary urban hospital from February 2005 to March 2015. The primary outcome was a difference in ECG findings between before and after closed thoracostomy. We specifically investigated the following ECG elements: PR, QRS, QTc, axis, ST segments, and R waves in each lead. The secondary outcomes were change in ST segment in any lead and change in axis after closed thoracostomy. RESULTS There were two ECG elements which showed statistically significant difference after thoracostomy. With right pneumothorax volume of greater than 80%, QTc and the R waves in aVF and V5 significantly changed after thoracostomy. With left pneumothorax volume between 31% and 80%, the ST segment in V2 and the R wave in V1 significantly changed after thoracostomy. However, majority of ECG elements did not show statistically significant alteration after thoracostomy. CONCLUSION We found only minor changes in ECG after closed thoracostomy in spontaneous pneumothorax patients.
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Affiliation(s)
- Wonjae Lee
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Yoonje Lee
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Bossng Kang
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Junghun Shin
- Department of Cardiology, Hanyang University Guri Hospital, Guri, Korea
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Arshad H, Khan RR, Khaja M. Case Report of S1Q3T3 Electrocardiographic Abnormality in a Pregnant Asthmatic Patient During Acute Bronchospasm. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:110-113. [PMID: 28144025 PMCID: PMC5297401 DOI: 10.12659/ajcr.901661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient: Female, 33 Final Diagnosis: S1Q3T3 electrocardiographic abnormality in a pregnant asthmatic during acute bronchospasm Symptoms: Cough • shortness of breath Medication: — Clinical Procedure: EKG Specialty: Pulmonology
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Affiliation(s)
- Hafiza Arshad
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Rana Rahel Khan
- Department of Medicine, Bronx Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
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An unusual case of primary spontaneous tension pneumothorax in a jamaican female. W INDIAN MED J 2014; 63:274-7. [PMID: 25314288 DOI: 10.7727/wimj.2013.301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/11/2013] [Indexed: 11/18/2022]
Abstract
Spontaneous pneumothorax is a well-recognized entity with a classical presentation of acute onset chest pain and shortness of breath. It may be complicated by the development of a tension pneumothorax or a haemopneumothorax. We report an interesting case of a spontaneous tension haemopneumothorax which presented atypically and was diagnosed on computed tomography (CT) scan of the chest. The clinical and pathophysiological characteristics and treatment of this unusual entity is discussed.
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Coppola G, Carità P, Corrado E, Borrelli A, Rotolo A, Guglielmo M, Nugara C, Ajello L, Santomauro M, Novo S. ST segment elevations: always a marker of acute myocardial infarction? Indian Heart J 2013; 65:412-23. [PMID: 23993002 PMCID: PMC3860734 DOI: 10.1016/j.ihj.2013.06.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 06/19/2013] [Indexed: 10/26/2022] Open
Abstract
Chest pain is one of the chief presenting complaints among patients attending Emergency department. The diagnosis of acute myocardial infarction may be a challenge. Various tools such as anamnesis, blood sample (with evaluation of markers of myocardial necrosis), ultrasound techniques and coronary computed tomography could be useful. However, the interpretation of electrocardiograms of these patients may be a real concern. The earliest manifestations of myocardial ischemia typically interest T waves and ST segment. Despite the high sensitivity, ST segment deviation has however poor specificity since it may be observed in many other cardiac and non-cardiac conditions. Therefore, when ST-T abnormalities are detected the physicians should take into account many other parameters (such as risk factors, symptoms and anamnesis) and all the other differential diagnoses. The aim of our review is to overview of the main conditions that may mimic a ST segment Elevation Myocardial Infarction (STEMI).
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Affiliation(s)
- G. Coppola
- O.U. of Cardiology, A.O.U. Policlinico “P. Giaccone”, University of Palermo, Italy
| | - P. Carità
- O.U. of Cardiology, A.O.U. Policlinico “P. Giaccone”, University of Palermo, Italy
| | - E. Corrado
- O.U. of Cardiology, A.O.U. Policlinico “P. Giaccone”, University of Palermo, Italy
| | - A. Borrelli
- O.U. of Electrophysiology, Policlinico Casilino, Rome, Italy
| | - A. Rotolo
- O.U. of Cardiology, A.O.U. Policlinico “P. Giaccone”, University of Palermo, Italy
| | - M. Guglielmo
- O.U. of Cardiology, A.O.U. Policlinico “P. Giaccone”, University of Palermo, Italy
| | - C. Nugara
- O.U. of Cardiology, A.O.U. Policlinico “P. Giaccone”, University of Palermo, Italy
| | - L. Ajello
- O.U. of Cardiology, A.O.U. Policlinico “P. Giaccone”, University of Palermo, Italy
| | - M. Santomauro
- O.U. of Cardiology, University of Medicine of Naples “Federico II”, Italy
| | - S. Novo
- O.U. of Cardiology, A.O.U. Policlinico “P. Giaccone”, University of Palermo, Italy
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Senthilkumaran S, Meenakshisundaram R, Michaels AD, Thirumalaikolundusubramanian P. Electrocardiographic changes in spontaneous pneumothorax. Int J Cardiol 2011; 153:78-80. [PMID: 21911271 DOI: 10.1016/j.ijcard.2011.08.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 08/14/2011] [Accepted: 08/17/2011] [Indexed: 10/17/2022]
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Jung J, Chang J, Oh S, Yoon J, Choi M. Computed tomography angiography for evaluation of pulmonary embolism in an experimental model and heartworm infested dogs. Vet Radiol Ultrasound 2010; 51:288-93. [PMID: 20469550 DOI: 10.1111/j.1740-8261.2009.01659.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study was performed to characterize pulmonary embolism with computed tomography pulmonary angiography in experimental pulmonary embolism and heartworm infected dogs. In the experimental group, there were pulmonary changes after pulmonary embolism induction as follows: hypoattenuating round filling defects in pulmonary arteries, arterial dilations with straight and abrupt cut-off appearances in the pulmonary embolism regions, pulmonary infarctions, a cavity formation and spontaneous pneumothorax, and emboli migration. In the heartworm-infected group, three out of eight dogs developed pulmonary embolism, especially in the right caudal arteries. Arterial dilations with typical tortuosity were also identified, mainly in the right caudal arteries in five dogs. Computed tomography pulmonary angiography can be an important imaging modality in the diagnosis of pulmonary embolism and the evaluation of pulmonary arterial and parenchymal changes in dogs.
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Soltani P, Malozzi CM, Abi Saleh B, Omar B. Electrocardiogram manifestation of spontaneous pneumothorax. Am J Emerg Med 2009; 27:750.e1-5. [PMID: 19751635 DOI: 10.1016/j.ajem.2008.09.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 09/20/2008] [Accepted: 09/23/2008] [Indexed: 10/20/2022] Open
Affiliation(s)
- Peyman Soltani
- Cardiology Department, University of South Alabama, Mobile, Alabama, AL, USA.
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Abstract
A 22-year-old male with cerebral palsy and respiratory failure had acute reversible ST-segment elevation in the inferior leads during acute collapse of the left lung, which resolved with re-expansion of the left lung several hours later. This suggests that major lung actelectasis needs to be added to the group of noncardiac conditions considered when evaluating ST elevation in the critically ill patient.
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Affiliation(s)
- Matt Sampson
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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Janssens U, Koch KC, Graf J, Hanrath P. Severe transmyocardial ischemia in a patient with tension pneumothorax. Crit Care Med 2000; 28:1638-41. [PMID: 10834727 DOI: 10.1097/00003246-200005000-00065] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report tension pneumothorax (TP) as a cause of severe myocardial ischemia. DESIGN Clinical case report. SETTING Medical intensive care unit of a university hospital. PATIENTS One patient with severe shock attributable to right TP after unsuccessful percutaneous central venous catheterization. INTERVENTIONS Blood pressure, electrocardiogram (ECG), chest radiograph, and echocardiography during and after shock. MEASUREMENTS AND MAIN RESULTS On admission the patient was in profound state of shock (heart rate 140 beats/min, blood pressure 65/30 mm Hg). Twelve-lead ECG showed pronounced ST segment elevation in leads II, III, aVF, and V4-V6. Chest radiograph revealed right TP with complete displacement of the mediastinum and the heart to the left side. Immediate right-sided tube thoracostomy resulted in reexpansion of the lung followed by instantaneous hemodynamic and respiratory improvement as well as nearly complete resolution of the ECG changes. Peak value of the creatine phosphokinase was 4140 U/L without significant elevation of the MB isoenzyme at any time. Moreover, the initial hypokinesia of the posterior and lateral left ventricular wall resolved completely, as demonstrated by echocardiography. CONCLUSION The specific condition of TP may lead to impaired systolic and diastolic coronary artery blood flow affecting ventricular repolarization and T-wave configuration in ECG indicative of transmyocardial ischemia. General symptoms, namely hypotension, tachycardia, and hypoxemia, are likewise typical for cardiogenic shock attributable to myocardial infarction. Yet any therapeutic measure directed toward revascularization, such as thrombolysis or even percutaneous transluminal coronary angioplasty, would have had devastating consequences. Therefore, thorough physical examination of our patient was pivotal in disclosing the true origin of profound shock.
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Affiliation(s)
- U Janssens
- Medical Clinic I, University of Aachen, Germany
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