ANALYSIS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CLINICAL PARAMETERS, ECG AND ECHO

CORRESPONDING AUTHOR:
Dr. Satish Kinagi,
Associate Professor,
Department of General Medicine,
MRMC , Gulbarga -585104.
Email: drafiya007@gmail.com

ABSTRACT: BACK GROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in countries of high, middle, and low income. Estimates from WHO’s Global Burden of Disease and Risk Factors project show that in 2001, COPD was the fifth leading cause of death in high-income countries, accounting for 3.8% of total deaths, and it was the sixth leading cause of death in nations of low and middle income, accounting for 4•9% of total deaths. OBJECTIVES: 1. To study clinical parameters of chronic obstructive pulmonary disease. 2. To find out Electrocardiographic changes of chronic obstructive pulmonary disease. 3. To confirm with echocardiogram the presence of pulmonary hypertension, tricuspid regurgitation and right heart failure and analyze the incidence of right heart failure and pulmonary hypertension. MATERIALS AND METHODS: Single center hospital based cross sectional study. Patients diagnosed as COPD based on following steps will be included in the study. The patients with cough, sputum production, dyspnoea (wheeze) was chosen (sputum AFB negative will be confirmed). Pulmonary function test was done to pick up patients with reduced FEV<70% was chosen. They were nebulized with salbutamol bronchodilator and PFT was repeated to select patients with <15% reversibility. All the data was tabulated and subjected to statistical analysis. Descriptive statistics, such as mean, SD and proportion, and other appropriate statistical tests used. OBSERVATIONS: Out of 72 patients, 39 patients were males, 34 were smoker.  Among 72 patients, 24 patients had P-pulmonalae, 41 patients had right axis deviation, 7 had R-wave height in lead V1 more than 5 mm according to ix electrocardiogram (indicating they had severe right ventricular hypertrophy or pulmonary hypertension). Among 72 patient, 17 were ecohocardiographically had pulmonary hypertension, 15 had tricuspid regurgitation (which is non-invasive method of measurement of pulmonary artery pressure), which we cannot afford to measure via catheter. 12 out of 72 patients had P-wave amplitude in lead II+ lead-III + lead aVF >9 mm, as this is the one of the indication for life long oxygen therapy as per American Thoracic Society (ATS). Out of 72 patients, 12 had coronary artery disease (CAHD) as this increases the incidence of cor-pulmonale. Cardiovascular Complications Out of 72 patients, 24% developed pulmonary hypertension, 22% developed tricuspid regurgitation, 34% had p-pulmonale, 18% had p-wave amplitude in lead-II + lead-III + lead a VF >9 mm, this is important because this is one of the indication for life long oxygen therapy. 18% had concomitant coronary artery disease (CAHD), this observation is important because systemic inflammation plays enhanced role in atherosclerosis, diabetes mellitus, tumour necrosis factor is increased in COPD patients. CONCLUSION: Pulmonary hypertension was the most common cardiovascular complication leading to corpulmonale, and emphysema was more common in smokers, bronchitis was more common in females, the prevalence of COPD was more in urban areas due to pollution of air by automobiles. The textile based industries were mainly responsible for the increased prevalence of COPD.
KEYWORDS: COPD; Pulmonary hypertension; Corpulmonale; Emphysema.