Reversible electrocardiographic changes in severe acute asthma.

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Abstract
Previous reports have documented the occurrence of reversible ECG changes including right axis deviation, P pulmonale, right bundle-branch block, and ST-segment and T-wave abnormalities in patients with acute attacks of asthma. In a further systematic study, the ECG of 63 patients admitted with severe acute asthma were evaluated. The most consistent change was an abnormally vertical P-wave axis in 78% of the patients. P pulmonale was present in 22% and right ventricular enlargement in only 1 patient. Right axis deviation, right bundle-branch block and rhythm abnormality were not present in any patient. In 11%, ST-segment or T-wave abnormalities suggesting myocardial ischemia were noted. These abnormalities persisted for up to 9 days and were unexplained. Other ECG abnormalities in acute asthma may reflect positional changes of the heart due to overdistension of the lungs. All ECG changes resolved after clinical improvement.