Diagnostics
Electrocardiographic manifestations of pulmonary embolism*,**

https://doi.org/10.1053/ajem.2001.27172Get rights and content

Abstract

The electrocardiogram (ECG) may be entirely normal in the patient with pulmonary embolism (P/E); alternatively, any number of rhythm and/or morphologic abnormalities may be observed in such a patient. The abnormal ECG may deviate from the norm with alterations in rhythm, in conduction, in axis of the QRS complex, and in the morphology of the P wave, QRS complex, and ST segment/T wave. The electrocardiographic findings associated with PE are numerous, including arrhythmias (sinus tachycardia, atrial flutter, atrial fibrillation, atrial tachycardia, and atrial premature contractions), nonspecific ST segment/T wave changes, T wave inversions in the right precordial leads, rightward QRS complex axis shift and other axis changes, S1Q3 or S1Q3T3 pattern, right bundle branch block, and acute cor pulomnale. This review focuses on the ECG and the various abnormalities seen in the patient with PE. (Am J Emerg Med 2001;19:514-519. Copyright © 2001 by W.B. Saunders Company)

Section snippets

Case 1

A 54 year-old man with a history of recent orthopedic surgery presented to the ED complaining of sudden dyspnea. On examination, he appeared in moderate distress because of dyspnea. His vital signs included a pulse of 125 beats/min., respiratory rate 36 breaths/min, pulse oximetry 92%, and blood pressure 165/90 mmHg. His examination was unremarkable except for a lower extremity which was casted. The patient was placed on a cardiac monitor and an ECG was obtained (Fig 1), showing sinus

Discussion

Pulmonary thromboembolism most commonly occurs as a complication of venous thrombosis, primarily from clots located in the deep veins of the lower extremities and pelvis. These clots dislodge from their origin and travel through the venous circulation to the pulmonary artery. The formation of venous thrombosis is usually caused by one or more of the following factors: endothelial injury, hypercoagulability, or stasis of blood. Common clinical situations associated with increased risk of

Conclusion

PE is a very elusive disease process lacking conclusive clinical findings to aid in the diagnosis. The true gold standard is pulmonary angiography. However, this cannot be done on every patient that presents with a concerning story. As an independent marker, the ECG continues to be a limited study because of its poor sensitivity. The transient nature of electrocardiographic abnormalities and the often nonspecific changes reduce the effectiveness of the test as a single agent. Serial ECGs do not

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