Reversible electrocardiographic changes in severe acute asthma.

Abstract

Siegler, D. (1977). Thorax, 32,[328][329][330][331][332] Reversible electrocardiographic changes in severe acute asthma. Previous reports have documented the occurrence of reversible electrocardiographic changes including right axis deviation, P pulmonale, right bundle-branch block, and ST-segment and T-wave abnormalities in patients with acute attacks of asthma. In a further systematic study, the electrocardiographs of 63 patients admitted with severe acute asthma have been evaluated. The most consistent change was an abnormally vertical P-wave axis in 78% of the patients. P pulmonale was present in 22% and right ventricular enlargement in only one patient. Right axis deviation, right bundle-branch block, and rhythm abnormality were not present in any patient. In 11%, ST-segment or T-wave abnormalities suggesting myocardial ischaemia were noted. These abnormalities persisted for up to nine days and were unexplained. Other ECG abnormalities in acute asthma may reflect positional changes of the heart due to overdistension of the lungs. All ECG changes resolved after clinical improvement.Reversible abnormalities in the electrocardiogram are well recognised in patients with acute attacks of bronchial asthma. Previously reported changes have included right axis deviation, prominent P waves suggesting right atrial enlargement, inversioIn of T waves, right bundle-branch block, and abnormalities of the ST segment (Gunstone, 1971;Rebuck and Read, 1971;Da Costa and Chia, 1974

The management of acute severe asthma

“…They include right axis deviation, clockwise rotation ofthe heart, evidence ofright ventricular hypertrophy, P pulmonale and ST segment or T wave abnormalities. They are not a contraindication to beta-agonist therapy and many changes resolve within hours of treatment (Rebuck & Read, 1971;Stark, 1972;Siegler, 1977;Webb et al, 1979).…”

Severe bronchial asthma requiring ventilation. A review of 20 cases and advice on management

“…Pulsus paradoxus (Rebuck and Pengelly, 1973) of more than 10 mmHg and ECG evidence of right heart strain or dysrhythmia (Siegler, 1977), are all indicators of the effect of high inflation pressures on the heart. Chest X-ray is essential and should be taken if possible just before ventilation.…”

Severe Acute Asthma

“…P pulmonale has been demonstrated in 50% of the patients in status asthmaticus with hypercapnia and acidosis, but in only 2.5% of the patients without these blood gas changes [16]. These electrocardiographic signs are readily revers ible within hours or days after successful bronchodilator treatment [17].…”