DiagnosticsElectrocardiographic manifestations of pulmonary embolism*,**
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
References (21)
- et al.
Diagnosis of acute pulmonary embolism in the elderly
Am Cardiol
(1991) - et al.
Clinical features of pulmonary embolism
Chest
(1995) - et al.
The Electrocardiographic manifestations of pulmonary embolism
Emerg Med
(1988) - et al.
Right ventricular dysfunction after acute pulmonary embolism: Pathophysiologic factors, detection and theraputic implications
Am Heart
(1995) - et al.
The ECG in pulmonary embolism
Chest
(1997) - et al.
The electrocardiographic manifestations of pulmonary embolism
Emerg Med
(1988) - et al.
Value of the 12-lead electrocardiogram at hospital admission in the diagnosis of pulmonary embolism
Am Cardiol
(1994) - et al.
The electrocardiogram in acute pulmonary embolism
Prog Cardiovasc Dis
(1975) - et al.
Diagnostic value of the electrocardiogram in suspected pulmonary embolism
Am Cardiol
(2000) - et al.
Gender, age and clinical signs of patients suspected of Pulmonary Embolism
Respiration
(1994)
Cited by (77)
62-Year-Old Woman With Diarrhea, Vomiting, and Chest Pain
2022, Mayo Clinic ProceedingsElectrocardiographic features of patients with COVID-19: One year of unexpected manifestations
2022, European Journal of Internal MedicineElectrocardiographic manifestations of COVID-19
2021, American Journal of Emergency MedicineCitation Excerpt :Other electrocardiographic presentations typical of PE include anterior T wave inversion and right bundle branch block [77,78]. In non-COVID-19 patients with PE, a normal ECG is encountered in approximately one-fifth of such individuals [80]. In patients with COVID-19 and critical illness, the ECG is rarely entirely normal when PE is diagnosed.
Electrocardiographic changes as a prognostic tool for hospitalized patients with pulmonary embolism
2020, Thrombosis ResearchPearls and Myths in the Evaluation of Patients with Suspected Acute Pulmonary Embolism
2019, American Journal of MedicineCitation Excerpt :Other electrocardiographic signs, such as the SIQIIITIII pattern (McGinn-White sign) and T-wave inversions in V1-V4, have been reported to be highly specific for pulmonary embolism.36 However, these and other electrocardiographic changes such as right bundle-branch block and right axis deviation, reflect right ventricular strain and therefore display a low sensitivity and low prevalence in patients with pulmonary embolism.37,38 The prognostic significance of a right ventricular strain pattern—indicative of right ventricular overload—in patients with acute pulmonary embolism remains controversial.
New Electrocardiographic Changes in Patients Diagnosed with Pulmonary Embolism
2017, Journal of Emergency MedicineCitation Excerpt :Only 24.1% of the ECGs reviewed in this study were unchanged from previous, with this finding more likely to occur in patients younger than 60 years. This value is similar to the 9% to 30% of “normal” ECGs that have been reported in previous studies (3,24–27). Sinus tachycardia was the only new dysrhythmia found at the time of PE diagnosis in our study, occurring in 27.3% of cases.