Chronic obstructive pulmonary disease

Electrocardiogram showing characteristic signs of severe COPD including sinus tachycardia (107 beats/min), peaked P waves in leads II, III, aVF, and V1 (P pulmonale), right axis deviation, and delayed precordial transition zone in which the net QRS area does not become positive until lead V5. Nonspecific ST-T abnormalities are also present. Although not seen here, patients with COPD often have low voltage in the limb leads.The prominent S wave in V3 raises consideration of left ventricular hypertrophy (eg, to to concomitant systemic hypertension).