Left-axis deviation and adiposity: The United States health and nutrition examination survey

Zack, Paul M.; Wiens, Robert D.; Kennedy, Harold L.

doi:10.1016/0002-9149(84)90649-0

Cited by 15 publications

(10 citation statements)

References 31 publications

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“…With increasing BMI there was a leftward shift of both atrial and ventricular vectors with the P wave axis affected most. This leftward change in the axes with increasing adiposity and rightward change in the axes with weight loss has been previously described; [5][6][7][8][9] however, this is the first large study to show Fig. 2.…”

Section: Discussionsupporting

confidence: 73%

The effects of body mass index on surface electrocardiograms in young adults

Nasir

Rubal

Jones

2012

Journal of Electrocardiology

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Section: Discussionsupporting

confidence: 73%

The effects of body mass index on surface electrocardiograms in young adults

Nasir

Rubal

Jones

2012

Journal of Electrocardiology

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“…In fact, the morbidly obese are the fastest growing segment of the US population (McCullough et al, 2005). As the abdomen becomes distended with adipose tissue, the hemidiaphragms are elevated, lung volumes reduced, and the heart takes on a characteristic leftward axis shift (Zack et al, 1984). In addition, growth of subcutaneous adipose tissue in the anterior trunk results in marked attenuation in the amplitude of sound waves audible to the stethoscope (Kinney, 1988).…”

Section: Discussionmentioning

confidence: 99%

Audiocardiography in the cardiovascular evaluation of the morbidly obese

McCullough

Zerka

Heimbach

et al. 2010

Clin Physio Funct Imaging

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Morbid obesity is believed to limit cardiovascular auscultation. We compared audiocardiography to senior attending physicians using conventional stethoscopes in 190 individuals with morbid obesity. Overall, there were 128 (67.4%) women and 62 (32.6%) men with mean ages of 44.9 +/- 12.3 and 51.3 +/- 10.8 , respectively (P = 0.001). The overall body mass index (BMI) was 47.3 +/- 8.5 kg m(-2). Of those with an S(3) by audiocardiography (n = 7), one had a history of coronary artery disease (CAD), none had a history of heart failure, and one had a left ventricular ejection fraction (LVEF) <45%. The mean LVEF was 58.6 +/- 9.9 versus 61.6 +/- 5.3 for those with and without an S(3) by audiocardiography (P = 0.16). By contrast, of those (n = 6) with an S(3) by stethoscope, one had a history of CAD, two had histories of heart failure, and 3 had LVEF < 45%. The mean LVEF of those with and without S(3) by stethoscope was 53.7 +/- 2.3 and 61.6 +/- 5.5%, respectively (P = 0.02). There were 40 (21.1%) patients with an S(4) (S(4) strength >5) identified by acoustic cardiography while there were 42 (22.1%) heard by the stethoscope and it was heard with both methods in nine patients (21.4% concordance). There were no significant correlations between BMI or peak oxygen consumption and S(3) or S(4) strength by audiocardiography. Acoustic cardiography performed with an electronic device was not helpful in assisting the cardiovascular examination of the morbidly obese. These data suggest the careful clinical exam with attention to traditional cardiac auscultation using a stethoscope in a quiet room should remain the gold standard.

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“…The axes are more vertical in thin individuals and more horizontal in heavy individuals [6]. Obesity may deviate the frontal plane QRS axis toward the left side but not further to the left than 0° and a left axis deviation to -30° or further leftwards in an obese person probably represents a pathological abnormality [2,23].…”

Section: Body Habitus and Obesitymentioning

confidence: 99%

Examining Left Axis Deviation

Bhattarai¹

2017

Interpreting Cardiac Electrograms - From Skin to Endocardium

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Axis deviation indicates possible presence of various conditions. It also affects the QRS and T morphologies. The limits of axis deviations are as such arbitrary and the approximate degree of axis itself can be easily determined. Various conditions often shift the QRS axis without fulfilling the defined limits of deviations in the initial stage. The associations with various conditions may be missed if such partial shift of the axis is disregarded. Isolated left axis deviation is relatively common in the general population and left anterior fascicular conduction delay is the most common cause of such isolated leftward shift of axis. Vulnerability of left anterior fascicle to interruption makes it likely to be affected by both atherosclerosis and fibrodegeneration. Glucose intolerance may increase the risk of both atherosclerosis and fibrodegeneration. The association of glucose intolerance with leftward shift of axis has been increasingly noticed. Research studies to get further evidences are required; however, utilizing the already available evidences to protect the susceptible population is equally essential. Documenting the approximate degree itself of the axis is the bottom line to study the association with the levels of various possible risk factors like glycated hemoglobin.

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Left-axis deviation and adiposity: The United States health and nutrition examination survey

Cited by 15 publications

References 31 publications

The effects of body mass index on surface electrocardiograms in young adults

The effects of body mass index on surface electrocardiograms in young adults

Audiocardiography in the cardiovascular evaluation of the morbidly obese

Examining Left Axis Deviation

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