Electrocardiographic changes in primary spontaneous pneumothorax: A retrospective observational study

Pneumothorax-induced electrocardiography (ECG) changes are common. However, the usage of ECG in diagnosing of pneumothorax remains limited. In addition, these changes could challenge the diagnosis of pneumothorax, particularly in patients with minimal symptoms. The objective of this study is to evaluate the ECG changes in patients with primary spontaneous pneumothorax (PSP). A retrospective observational study was conducted at King Abdullah University Hospital among patients diagnosed with PSP between January 2018 and December 2023. Patients who had PSP with ECG performed before chest tube insertion were included in the study. Data on patient demographics, ECG changes, and pneumothorax volume were collected. Eighteen patients with PSP met the inclusion criteria for this study. The most frequent ECG findings in all patients were incomplete right bundle branch block (RBBB) and S < 1.2mV in V2; both were observed in 17 out of the 18 ECGs (94%). For patients with left-sided PSP, the most frequent ECG changes were S < 1.2mV in V2 and S < 0.9mV in V3; both were observed in 6 out of 7 ECGs (85%). Among those with right-sided PSP, the most frequent findings were incomplete RBBB and S < 1.2mV in V2, occurring in 10 out of 11 ECGs (90.9%). Incomplete RBBB and S < 1.2mV in V2 were present in all cases of PSP with a size > 50%. The relationship between pneumothorax and ECG changes induced by pneumothorax is well established. However, these changes are not statistically significant. Despite this, they could play a role in supporting the diagnosis of pneumothorax in patients with clinical symptoms and signs of pneumothorax.