P-wave changes in obstructive and restrictive lung diseases

To evaluate the P wave changes in the electrocardiogram (ECG) in chronic lung diseases, we examined ECGs from twenty patients with interstitial pulmonary fibrosis (the FLD group) and twenty patients with chronic obstructive lung disease (fifteen with pulmonary emphysema and five with bronchial asthma, the COLD group). In the COLD group, the amplitude of P waves in leads II and III increased and the axis of the P wave shifted rightward. In the FLD group, however, these changes were not observed. Furthermore, the axis of the P wave exceeded +70 degrees in all the patients in the COLD group, and was less than +70 degrees for all the patients in the FLD group. The increased P wave terminal force in lead V1 was found in nine patients (45%) of the FLD group and in ten patients (50%) in the COLD group. We concluded that the rightward shift of the axis of the P wave was a characteristic of obstructive lung disease and that it was mainly caused by the overinflation of the lung. This P wave change was not observed in interstitial pulmonary fibrosis.