University of Massachusetts Medical School Faculty Publications

UMMS Affiliation

Department of Medicine, Division of Cardiovascular Medicine

Publication Date


Document Type



Aged; *Electrocardiography; Female; Humans; Male; Mass Screening; Pulmonary Emphysema; Smoking


Cardiology | Diagnosis | Respiratory Tract Diseases


BACKGROUND: Pulmonary emphysema of any etiology has been shown to be strongly and quasidiagnostically associated with a vertical frontal P wave axis. A vertical P wave axis (>60 degrees) during sinus rhythm can be easily determined by a P wave in lead III greater than the P wave in lead I (bipolar lead set) or a dominantly negative P wave in aVL (unipolar lead set). The purpose of this investigation was to determine which set of limb leads may be better for identifying the vertical P vector of emphysema in adults.

METHODS: Unselected consecutive electrocardiograms from 100 patients with a diagnosis of emphysema were analyzed to determine the P wave axis. Patients aged younger than 45 years, those not in sinus rhythm, and those with poor quality tracings were excluded. The electrocardiographic data were divided into three categories depending on the frontal P wave axis, ie, >60 degrees, 60 degrees, ordegrees, by each criterion (P amplitude lead III > lead I and a negative P wave in aVL).

RESULTS: Sixty-six percent of patients had a P wave axis > 60 degrees based on aVL, and 88% of patients had a P wave axis > 60 degrees based on the P wave in lead III being greater than in lead I.

CONCLUSION: A P wave in lead III greater than that in lead I is a more sensitive marker than a negative P wave in aVL for diagnosing emphysema and is recommended for rapid routine screening.


P wave axis, Electrocardiography, Emphysema

Rights and Permissions

Copyright 2013 Bajaj et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

DOI of Published Version



Bajaj R, Chhabra L, Basheer Z, Spodick DH. Optimal electrocardiographic limb lead set for rapid emphysema screening. Int J Chron Obstruct Pulmon Dis. 2013;8:41-4. doi: 10.2147/COPD.S37776.Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

International journal of chronic obstructive pulmonary disease

PubMed ID




To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.