Which EKG change is most consistent with COPD?

• A. LVH
• B. L atrial enlargement
• C. AFIB
• D. RVH

Answer: (D)

Chronic hypoxemia from COPD leads to vasoconstriction of the pulmonary vessels and increased pulmonary pressures, placing a heavy load on the right ventricle. Over time this causes right ventricular hypertrophy and signs of right-heart strain, a pattern often termed cor pulmonale. On the ECG, this shows up as right-sided changes such as right axis deviation and prominent right-precordial activity (for example, relatively larger R waves in the right chest leads like V1–V2 with deeper S waves to the left). There may also be signs of right atrial enlargement, such as tall P waves, but the key theme is RVH reflecting the pressure overload from pulmonary hypertension. LVH would point to left-sided pressure overload, left atrial enlargement suggests chronic left-sided disease, and AFib is an arrhythmia rather than a structural adaptation, though COPD can be associated with AFib, it’s not the classic COPD-related EKG change.