Skip main navigation

Poor R-Wave Progression in the Precordial Leads in Left-Sided Spontaneous Pneumothorax

Originally published 2009;120:2122

    A 30-year-old man without any cardiovascular history was transferred to our hospital because of chest pain. On arrival, his blood pressure was 166/93 mm Hg, with a pulse rate of 58 bpm. His oxygen saturation level was 98%. His ECG showed normal sinus rhythm, with poor R-wave progression in the precordial leads (Figure, A). The white blood cell count was 7990/mm3, and the level of creatine kinase was 93 IU/L (normal range <163). Left ventricular wall motion was normal on echocardiography. The chest x-ray revealed left-sided spontaneous pneumothorax (Figure, A). After simple aspiration with cannula, the left lung was reexpanded, and the poor R-wave progression in the precordial leads was completely resolved (Figure, B).

    Figure. ECG and chest radiograph of patient on arrival (A) and after aspiration (B). A, ECG showed normal sinus rhythm with poor precordial R-wave progression, and the collapse of the left lung was seen on the chest radiograph (arrows). B, After simple aspiration, both abnormalities as demonstrated by ECG and chest radiograph improved.

    Pneumothorax and myocardial infarction are common diseases presenting chest pain, and ECG is one of the most important diagnostic tools for them. Here, we describe ECG findings with left-sided pneumothorax mimicking anterior myocardial infarction. The mechanism of poor precordial R-wave progression in this patient seemed to be rotation of the heart due to intrathoracic air, because the ECG findings immediately improved after simple aspiration. Left-sided pneumothorax should be considered in patients with chest pain and suspected anterior myocardial infarction on ECG.




    Correspondence to Wataru Mitsuma, MD, Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, 1–754 Asahimachi dori, Chuoku, Niigata 951–8510, Japan. E-mail


    eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.

    Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.