Case 27: A 70-Year-Old Man in the ICU with Respiratory Failure
History
Diagnosis
History
This 70-year-old man with COPD is admitted to the ICU with severe respiratory failure:
Diagnosis
- Atrial flutter with 2:1 AV conduction (changing to variable AV conduction during the last 2 seconds of recording)
- Left axis deviation
- Low QRS voltage in the limb leads (QRS voltage < 5mm)
- Poor R wave progression in the chest leads ( R is taller than S in V6)
Comment: These findings are suggestive of chronic pulmonary disease. Patients with severe pulmonary emphysema may have right or left axis deviation. There have been a number of explanations for the LAD, one being that the emphysematous lung gives “an illusion” of axis deviation by affecting the conduction of the electrical activity of the heart to the chest wall.
ECG ID: E587