Advanced Patient Assessment Practice Exam

Which of the following would be a typical ECG finding in a patient with emphysema?

1. Smaller-than-normal P waves

2. Prominent QRS complexes, particularly in leads V5 and V6

3. Reduced voltage in the limb leads

4. Left axis deviation

The correct answer is: Reduced voltage in the limb leads

In patients with emphysema, reduced voltage in the limb leads on an ECG is a typical finding due to the hyperinflation of the lungs that can lead to a decrease in overall cardiac electrical activity transmitted to the surface electrodes. The lungs can become distended, pushing the diaphragm downward and altering the position of the heart. This change can lead to a decrease in the amplitude of the electrical signals recorded, resulting in a lower voltage reading. This phenomenon occurs because the heart may be positioned more vertically due to the increased lung volume, which affects how the electrical impulses are captured in the limb leads. Consequently, diminished voltage in the limb leads is indeed a common ECG finding associated with chronic obstructive pulmonary disease (COPD), particularly emphysema, as the hypertrophy or other structural changes may not be significant enough to show prominent voltage increases. In contrast, the other options, such as smaller P waves, prominent QRS complexes, or left axis deviation, are not typically associated with emphysema. Smaller P waves may indicate atrial enlargement but are not exclusive to emphysema; prominent QRS complexes are often seen in conditions with greater cardiac involvement or hypertrophy, and left axis deviation is generally related to underlying structural heart disease rather than isolated emph