Related Experiment Video
Updated: May 29, 2026
05:56
Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit
Published on: September 6, 2024
Transient Super-Himalayan P-waves in severe pulmonary emphysema
Lovely Chhabra1, David H Spodick
1Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA.
Journal of Electrocardiology
|September 13, 2011
Summary
Transient Himalayan P-waves, typically linked to congenital heart disease, were observed in a patient with severe emphysema exacerbation. This case highlights a novel association, suggesting pulmonary issues can transiently cause these giant P-waves.
Area of Science:
- Cardiology
- Pulmonology
- Electrocardiography
Background:
- Himalayan P-waves are usually indicative of congenital heart disease with right-to-left shunting, often associated with a dilated right atrium.
- These P-wave abnormalities are typically persistent and linked to structural cardiac changes.
Observation:
- A case report details a patient experiencing transient, high-amplitude (9-mm) Himalayan P-waves during a severe emphysema exacerbation.
- The patient presented with a normal right atrial size, contrasting with typical findings.
Findings:
- The giant P-waves were attributed to severe pulmonary hyperinflation, right atrial hypoxia, and acute mechanical stress on the right atrium due to bronchospasm.
- This transient manifestation of Himalayan P-waves, particularly of this amplitude, has not been previously documented.
Implications:
- This finding expands the differential diagnosis for Himalayan P-waves beyond congenital heart disease.
- It suggests that severe pulmonary conditions, like emphysema exacerbation, can induce significant, albeit transient, electrocardiographic changes in the right atrium.
Related Concept Videos
01:29Pulmonary Embolism I: Introduction
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
01:19Pulmonary Embolism I: Introduction
A blood clot, or thrombus, is a semi-solid mass composed of fibrin, platelets, and red blood cells. When it forms within a vessel, it can obstruct blood flow, known as thrombosis. If part of the clot detaches, it becomes an embolus that can travel and block distant vessels. When this occurs in the pulmonary arteries, it causes a condition known as pulmonary embolism (PE).Origin and ImpactMost often, the embolus originates from a thrombus in the deep veins of the lower limbs, a condition called...
01:23Chronic Obstructive Pulmonary Disease II: Emphysema
Emphysema, a major phenotype of chronic obstructive pulmonary disease (COPD), is characterized by irreversible destruction of alveolar walls and permanent enlargement of distal airspaces. Unlike chronic bronchitis, which primarily affects the airways, emphysema predominantly involves the lung parenchyma, where structural damage leads to airflow limitation.PathophysiologyIt most commonly results from prolonged exposure to cigarette smoke and other toxic gases, particularly cigarette smoke.
01:18Pulmonary Edema II: Pathophysiology
Pulmonary edema is the accumulation of fluid in the interstitial and alveolar spaces of the lungs, impairing gas exchange and oxygen delivery. It may be cardiogenic or noncardiogenic, but both reduce oxygenation and lung compliance.Cardiogenic Pulmonary EdemaCardiogenic edema results from increased hydrostatic pressure in pulmonary capillaries, usually due to left ventricular dysfunction from myocardial infarction, heart failure, or valvular disease. Ineffective cardiac pumping causes blood to...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
01:27Pneumothorax-II
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations: