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Electrocardiogram in chronic cor pulmonale.

A 14-year follow-up study of 544 patients with proven chronic cor pulmonale with 966 serial records was made. This is probably the largest series reported upon. Among significant serial changes were those in the configuration of the P and T waves which were the most labile and in the P and QRS axes which were less so. Right axis deviation of the P axis was found in 57 per cent, of the QRS axis in 79 per cent, and a qR pattern in aVR in 45 per cent. In the praecordial leads a classical right ventricular hypertrophy pattern was seen in nearly 75 per cent, incomplete right bundle-branch block in I5.4 per cent, a QS pattern in all chest leads in 17 per cent, left ventricular hypertrophy in 4-2 per cent, and combined ventricular hypertrophy in 4 per cent. The pattern of right ventricular hypertrophy was commonly a qR with R below 5 mm; Rs and R were much less common. qR and incomplete right bundle-branch block patterns interchanged freely in serial records and were sometimes present in the same record. The suggested reasons for these are a basic diastolic overload with a superimposed systolic overload, both of which are responsible for the genesis of the right ventricular hypertrophy pattern in cor pulmonale. An rS in V5-V6 was seen in 78 per cent of patients. Transient inversion of the T wave in all chest leads occurred in 23 per cent which could not be put down to digitalis or ventricular hypertrophy. These