The criteria used by the program are associated with right ventricular hypertrophy or dilation. The most common pathophysiological basis of this abnormality is chronic obstructive lung disease and pulmonary hypertension.

If the pulmonary disease criteria are new when comparing to previous tracings, consider the clinical presentation for pulmonary embolus (tachycardia, pleuritic chest pain, presence of cancer, immobilization) or exacerbation of lung disease. The patient may require hospitalization and treatment with heparin for PE or bronchodilators, antibiotics and steroids for COPD. If the pulmonary disease criteria are a stable finding, examine the patient for lung disease (prolonged expiration, hyperresonance, rhonchi and distant breath sounds, lowered diaphragms) and consider history and exposures including asbestos, coal dust and cigarette smoking. Pulmonary function testing may be indicated.