ECG and Echocardiographic Findings in COPD and the Correlation of Right Ventricular Dysfunction with the Severity of COPD

BACKGROUND: COPD is one of the most important cause of morbidity & mortality throughout the world. It is characterized by respiratory symptoms & airflow limitation which is due to alveolar & airway abnormalities. Pulmonary arterial hypertension affects the function of right ventricle leading to corpulmonale & has a poor prognosis. AIMS AND OBJECTIVES: To study the electrocardiography & echocardiography findings in COPD & compare the results of clinical, ECG, ECHO findings in detecting the right ventricular dysfunction & correlate with disease severity. MATERIALS & METHODS: This study is conducted at Kanyakumari Government Medical College Hospital. It is a Prospective Observational study with a sample Size of 100 patients for 10 months. All patients underwent PFT & diagnosis of COPD is made based on WHO GOLD criteria. They are subjected to ECG, Chest X-ray & ECHO for evidence of right ventricular hypertrophy, right ventricular dilatation & pulmonary hypertension. RESULTS: COPD is more common in smokers with male to female ratio of 6.14:1 & is more common in the 5th & 6th decade. The major symptoms were breathlessness & chronic cough with expectoration. Majority of patients (74%) had severe & very severe COPD by spirometry. Clinical Evidence of RV failure was seen as increased JVP (36%), parasternal heave (30%) pedal edema (32%), ascites (9%), loud & palpable P2 (35%). By chest X-ray, hyperinflated lung fields & increased bronchovascular markings were the most frequent changes. 53% of the patients had ECG evidence of RVH & it correlated significantly with the severity of disease. Overall incidence of corpulmonale was found in 59% by echocardiography& is highly significant (p < 0.001). CONCLUSION: Corpulmonale is a common complication of COPD & detection of corpulmonale in early stage is important for therapeutic & prognostic implication. The diagnosis of corpulmonale in COPD patients is 36% by general physical examination, 30% by chest Xray, 45% by ECG & 59% by 2D echocardiography. By physical examination, CXR & ECG collectively, diagnosis of corpulmonale in COPD patients is 51% while by 2D ECHO alone is 59%. It is recommended to carry out physical examination, chest X-ray & ECG where ECHO is not available. Echocardiography is more sensitive & better than other modalitiesfor early detection of corpulmonale& better management of cases