ECG Evaluation in Patients with Pneumothorax Admitted to the Emergency Department: A Three years Analysis

Abstract

Objective: Pneumothorax is one of the life-threatening differential diagnoses of patients presenting to emergency department (ED) with shortness of breath and chest pain. The place of dynamic electrocardiography (ECG) changes in diagnosis of pneumothorax was not well defined. The aim of our study was to reveal the clinical importance of ECG in pneumothorax. Methods: Between 01.04.2014 and 01.04.2017, 147 patients who applied to our ED and take a diagnosis of pneumothorax were retrospectively examined. The patients were divided as Group 1 (with pneumothorax volume <20%), and group 2 (with pneumothorax volume≥ 20%). Patient demographics, mechanism of pneumothorax formation (traumatic or spontaneous), X ray and tomographic findings, ECG findings, hospitalization-follow-up periods, treatment methods; were derived from the hospital's data recording system and compared between groups. Results: 109 (74.1 %) of 147 patients had a traumatic pneumothorax, and 38 (25.8%) had a spontaneous pneumothorax (p <0.001). 21 (55.2%) of the spontaneous pneumothorax cases are primary spontaneous pneumothorax. 64.6% (n=95) of the patients had chest pain. The two groups were similar in terms of age, hemoglobin level, GCS, number of days followed, gender and smoking status, (p> 0.05). When the ECG data was analyzed, a difference was found between the two groups. While 52.8% of the patients in group 1 had ECG changes, all of the patients in group-2 (100%) had unusual ECG findings (p = 0.004). Conclusions: Pneumothorax is a condition that should not be overlooked at ED. Pneumothorax especially with large volume size (size≥20%) should be remembered in cases with abnormal findings in their ECG.

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“…ST segment elevation/depression on an ECG can be seen due to various causes. These include acute myocardial infarction, early repolarization, coronary vasospasm (Prinzmetal's angina), pericarditis, left bundle branch block, left ventricular hypertrophy, ventricular aneurysm, Brugada syndrome, increased intracranial pressure, Takotsubo cardiomyopathy, pulmonary thromboembolism, pneumothorax, cardiac contusion, hypothermia, and hyperkalemia, etc [6][7][8][9]. In our case, acute coronary syndrome was ruled out, and no significant pathology was observed apart from hemopericardium.…”