Diaphragm levels as determinants of P axis in restrictive vs obstructive pulmonary disease

Chest
N S ShahDavid Spodick

Abstract

Verticalized P axes in adults with obstructive lung disease have long been appreciated as characteristic of emphysema. After demonstrating P axes in restrictive lung disease to have a significantly different orientation (intermediate to horizontal), it was hypothesized that opposite effects on diaphragm level by obstructive disease (low diaphragm) and by restrictive disease (high diaphragm) could explain the axis differences, because the right atrium is attached via the inferior vena cava and adjacent pericardium to the right leaf of the diaphragm. Electrocardiograms and chest radiographs were analyzed independently in a new series of 20 consecutive patients with purely obstructive and 19 consecutive patients with purely restrictive pulmonary disease. P axes were calculated to the nearest 5 degrees and grouped as vertical (+65 degrees to +90 degrees), intermediate (+40 degrees to +60 degrees), and horizontal (< +50 degrees). Chest radiographs established the right diaphragmatic level by posterior rib number or interspace with interspaces designated as "0.5" plus the number of the rib above. P axes for obstructive vs restrictive disease were different (p < 0.001) as in our previous investigation. In the present series, 19 of 20 ...Continue Reading

Citations

Mar 20, 1999·Clinical Cardiology·R Baljepally, David Spodick
May 15, 2008·Lung·Jason ElinoffAtul Malhotra
Dec 31, 1997·American Journal of Respiratory and Critical Care Medicine·S S KrishnanA J Dozer
Feb 5, 2013·International Journal of Chronic Obstructive Pulmonary Disease·Rishi BajajDavid Spodick
May 22, 2013·International Journal of Chronic Obstructive Pulmonary Disease·Lovely ChhabraDavid Spodick
Nov 29, 2015·Emergency Medicine Clinics of North America·Salvador J Suau, Peter M C DeBlieux
Jan 22, 2011·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Dvorah HoltzmanDipak Chandy
Jun 1, 1996·American Heart Journal·David Spodick
Feb 11, 2011·The American Journal of Cardiology·Anish J ThomasDavid Spodick
Oct 31, 2017·European Journal of Preventive Cardiology·Øyunn Kleiven, Stein Ørn
Mar 24, 2021·BMC Pulmonary Medicine·Hiroyuki YamamotoYoshiyasu Aizawa

Related Concepts

Respiratory Diaphragm
Electrocardiographic Recorders
Cardiac Conduction System
Lung Diseases
Lung Diseases, Obstructive
Diagnostic Radiologic Examination
Respiratory Function Tests
Atrial Function

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