Electrocardiographic Characteristics in a Large Cohort of Acute Pulmonary Embolism

An Older Patient With Chest Pain—Diagnostic Traps

“…Nonspecific ECG features may be seen in patients with PE, including sinus tachycardia, T-wave inversion, right bundle-branch block, STE, axis deviation, atrial fibrillation, among others. 2 Given the STE in the right leads and STD in the left and inferior leads, persistent chest pain, and elevated cTnI in this patient, the ED physician's diagnosis was misled to ACS. However, reciprocal ST alterations are rational for PE instead of common occlusive coronary artery disease and cannot be used to rule out PE.…”

“…A rapid ECG is important to physicians in outpatient and ED settings in identifying PE. Nonspecific ECG features may be seen in patients with PE, including sinus tachycardia, T-wave inversion, right bundle-branch block, STE, axis deviation, atrial fibrillation, among others …”

“…Although the S1Q3T3 pattern is widely accepted for APE, its sensitivity is only 10.5%. 2 Patients with APE mostly have both rapid breathing and rapid pulse (heart rate), with chest pain exacerbated during inspiration, and patients with ACS usually do not. 5 According to Kosuge and colleagues, 6 the combination of the negative T-wave in leads III and V 1 and the greatest negative T-wave among precordial leads occurring in leads V 1 to V 2 can accurately identify APE and exclude ACS, with 98% sensitivity, 92% specificity, and 94% predictive accuracy.…”

“…Therefore, it is essential for physicians to grasp the differences between ECG characteristics of APE vs ACS. Although the S1Q3T3 pattern is widely accepted for APE, its sensitivity is only 10.5% . Patients with APE mostly have both rapid breathing and rapid pulse (heart rate), with chest pain exacerbated during inspiration, and patients with ACS usually do not .…”

'Leads' that lead: A patient with tachypnoea, tachycardia, hypotension and an uncommon ECG finding

“…In such cases, it may prompt toward performance of a rapid bedside echocardiogram to look for changes that further support a PE diagnosis, and thus guide critical decision making to initiate definitive therapy as soon as possible. [ 9 ]…”