A STUDY OF ACUTE COMMUNITY-ACQUIRED PNEUMONIA, INCLUDING DETAILS OF CARDIAC CHANGES

We prospectively studied 102 patients, aged 15-50 years, with acute co mmunity-acquired lobar pneumonia without underlying cardiorespiratory illness, admitted to Baragwanath Hospital May 1990-April 1991. Demogra phic, clinical, microbiological and laboratory data and negative progn ostic features of these patients are described. In particular, we docu mented electrocardiographic changes and studied their possible relevan ce in patients with pneumonia. Electrocardiographic changes occurred i n 32 patients (31%). The commonest changes were clockwise rotation (16 %), followed by P. pulmonale (9.8%) and S1 Q3 T3 pattern (7.8%) Other changes included right axis deviation (n=6), right bundle branch block (n=3), ventricular extrasystoles (n=2), atrial fibrillation (n=1) and nodal rhythm (n=1). These changes returned to normal in survivors aft er a mean of 2 days. The S1 Q3 T3 pattern was associated with cardiac enzyme leak (CK-MB fraction), hypoxia and a high Simplified Acute Phys iology Score (SAPS). In addition, P. pulmonale, right axis deviation a nd clockwise rotation correlated with hypoxia and a high SAPS score. C lockwise rotation also correlated with serum (including cardiac fracti on) enzymes leak (LDH and CK-MB fraction), and pulmonary artery pressu re.