Electrocardiograms of Right Ventricular Hypertrophy in Bilharzial Cor Pulmonale.

The clinical manifestations and differential diagnosis of bilharzial cor pulmonale are well established (Bedford, Aidaros, and Girgis, 1946; El Ramly et al., 1953; Salah, 1958, Badawi et al., 1961). It is usually possible to differentiate between early and advanced cases, but more refined grading is not easy to achieve at the bedside. Our attempts to grade the clinical signs of right ventricular hypertrophy or the auscultatory signs in the pulmonary area proved unsuccessful and failed to predict the height of the pulmonary artery pressure. Radiological examination is not helpful in detecting mild right ventricular enlargement or in assessing the degree of right ventricular hypertrophy. The size of the pulmonary artery is not related to the degree of pulmonary hypertension (Salah, 1958; Badawi et al., 1961). Application of the knowledge gained from pulmonary arteriography in the interpretation of the plain radiograph (Salah et al., 1963) has helped in judging the degree of underlying arterial changes. The signs in the plain radiograph, however, are not sufficient for accurate assessment. It seemed that electrocardiography might prove helpful in assessing the severity of the disease. Cosby et al. (1952, 1953), Walker, Helm, and Scott (1955), Walker, Scott, and Helm (1955), and Goodwin and Abdin (1959) found a correlation between electrocardiographic changes and the degree of pulmonary hypertension as well as the size of the right ventricle at necropsy, in congenital and acquired cor pulmonale. The cardiographic changes were affected not only by the degree of pulmonary hypertension but also by the nature of the disease studied, and as a whole the changes were more pronounced in the congenital group (Goodwin and Abdin, 1959). El Sherif (1953) correlated the electrocardiographic findings with the hlmodynamic data in 16 patients with bilharzial cor pulmonale; he thought that right ventricular hypertrophy was preceded by a stage of right ventricular dilatation which produced slurring or notching of the right praecordial complexes. These changes disappeared when right ventricular hypertrophy was established, and the electrocardiogram showed a pattern of pure right ventricular hypertrophy. Naim (1955) reported on the vectorcardiogram in bilharzial cor pulmonale and stressed that the pattern was consistent with a "systolic overload" and that bundle-branch block was absent. Of 26 patients studied by Foda (1959), 7 had incomplete, and 1 had complete, right bundle-branch block. He considered that the pattern of incomplete right bundle-branch block occurred with high systolic load when the total pulmonary resistance was more than 9 5 units. This paper reports the electrocardiographic findings and their relation to the hemodynamic data in bilharzial cor pulmonale.