The ECG is often but not always abnormal in pulmonary arterial hypertension. The most sensitive feature is RV strain (ST depression and T wave inversion in leads V1 to V3). Other changes found include right axis deviation, P pulmonale, right bundle branch block, tall R waves especially anteriorly and prolonged QTc.
Links to further reading:
- Rich et al. Primary pulmonary hypertension. A national prospective study. Annals of Internal Medicine 1987; 107:216-223
- The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal (2016) 37, 67–119
- Peacock et al. Chapter 9. Clinical Features. in Pulmonary Circulation: Diseases and their Treatment, Ed Peacock et al. 2016 pg105-123
- Bondermann D et al. A non-invasive algorithm to exclude pre-capillary pulmonary hypertension. ERJ 2011; 37:1096-1103