Electrocardiographic responses to pulmonary embolism

Spodick, David H.

doi:10.1016/0002-9149(72)90613-3

Cited by 29 publications

(17 citation statements)

References 16 publications

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“…Acute PE is associated with a number of ECG abnormalities, but has extremely diverse manifestations and is liable to be affected by factors such as the degree of hemodynamic instability and the timing of ECG recording. [9][10][11][12][13][14][15][16][17][18] Of the many ECG abnormalities associated with acute PE, inverted T waves are the most common, 9,11,14,15,17 as well as the most persistent change. 9,11 Inverted T waves occur in 17-68% of patients with acute PE.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11] Experimental and clinical evidence suggests that myocardial ischemia and even right ventricular infarction may result from an acute rise in pulmonary artery pressures, subsequently leading to right ventricular failure. [23][24][25][26] Severe ischemia may alter the pathway of electrical repolarization, resulting in inverted T waves.…”

Section: Discussionmentioning

confidence: 99%

“…9 We analyzed the following ECG findings previously shown to be associated with PE: (1) arrhythmias; (2) pulmonary P: P waves ≥2.5 mm in limb leads or ≥1.5 mm in lead V1; (3) right axis deviation: QRS electrical axis >90°; (4) left axis deviation: QRS electrical axis ≤-30°; (5) complete right bundle block: QRS intervals ≥0.12 s; (6) incomplete right bundle block: QRS intervals = 0.10-0.11 s; (7) S1S2S3: the presence of S waves of at least 1.5 mm amplitude in leads I, II and III; (8) S1Q3T3: the presence of S waves in lead I and Q waves in lead III, each having amplitudes of ≥1.5 mm, in association with negative T waves in lead III; (9) low voltage: greatest overall deflection of the QRS complex ≤5 mm in all limb leads; (10) right ventricular hypertrophy: the presence of R waves >5 mm or an R/S ratio of ≥1 in lead V1; (11) clockwise rotation: a shift in the transition zone (R = S) in the precordial leads to V5 or beyond; (12) ST elevation: elevation of ST segments ≥1.0 mm in any lead except lead aVR; and (13) ST depression: depression of ST segments ≥0.5 mm in any lead in the absence of complete bundle branch block or ventricular hypertrophy. [9][10][11][12][13][14][15][16][17][18] Echocardiographic Evaluation Right ventricular function was assessed using transthoracic echocardiography. Right ventricular dysfunction was diagnosed if patients had any of the following findings: (1) abnormal motion of the interventricular septum; (2) dilation of the right ventricle (diastolic diameter ≥30 mm); (3) hypokinesis of the right ventricle; or (4) tricuspid valve regurgitation (jet velocity >2.5 m/s).…”

Section: Electrocardiographic Evaluationmentioning

confidence: 99%

“…Various ECG findings specific for acute PE have been reported; however, the relationship between ECG findings and the severity of acute PE remains unclear. [9][10][11][12][13][14][15][16][17][18] Inverted T waves are frequently observed in lead III and precordial leads in patients with acute PE. 9,11,14,15,17 Some, 9,15,16 but not all, studies have shown that inverted T waves are related to the severity of acute PE.…”

mentioning

confidence: 99%

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Prognostic Significance of Inverted T Waves in Patients With Acute Pulmonary Embolism

Kosuge

Kimura

Ishikawa

et al. 2006

Circ J

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Background The significance of inverted T waves remains unclear in patients with acute pulmonary embolism (PE). Methods and ResultsThe relationship of the number of leads with inverted T waves to the severity of PE in 40 patients with acute PE was studied. Patients were classified into 3 groups according to the number of leads with inverted T waves on the admission electrocardiogram (ECG): 15 patients, ≤3 leads (group L); 12 patients, 4-6 leads (group M); and 13 patients, ≥7 leads (group H). In groups L, M and H, the rates of right ventricular dysfunction on echocardiography were 47%, 92% and 100% (p<0.01), respectively, and the rates of in-hospital complicated events (including death or the need for catecholamine support, cardiopulmonary resuscitation or mechanical cardiovascular support because of hemodynamic instability) were 0%, 8% and 46% (p=0.004), respectively. On multivariate analysis, arterial hypotension at presentation (odds ratio (OR) 8.96, p=0.049) and inverted T waves in ≥7 leads on the admission ECG (OR 16.8, p=0.037) were the only independent predictors of in-hospital complicated events. Conclusions The number of leads with inverted T waves may be a useful and simple marker of increased risk for early complications in patients with acute PE. (Circ J 2006; 70: 750 -755)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Electrocardiographic Evaluationmentioning

confidence: 99%

mentioning

confidence: 99%

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Prognostic Significance of Inverted T Waves in Patients With Acute Pulmonary Embolism

Kosuge

Kimura

Ishikawa

et al. 2006

Circ J

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“…Dobro je poznat značaj ovog odvoda u akutnoj plućnoj tromboemboliji gde pored dijagnostičke ima i prognostičku vrednost (1)(2)(3)(4). Njegov značaj se pored kardioloških oboljenja opisuje i u dijagnozi trovanja tricikličnim antidepresivima (5, 6) i tenzionom pneumotoraksu (7).…”

Section: Uvodunclassified

10.5937/mckg48-4068 = Diagnostic and prognostic utility of aVR lead in electrocardiogram

Ivanov¹,

Jaraković²,

Dejanovic³

et al. 2014

Medicinski casopis

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UVODU interpretaciji elektrokardiograma, aVR odvod ima višestruku kliničku primenu. Dobro je poznat značaj ovog odvoda u akutnoj plućnoj tromboemboliji gde pored dijagnostičke ima i prognostičku vrednost (1-4). Njegov značaj se pored kardioloških oboljenja opisuje i u dijagnozi trovanja tricikličnim antidepresivima (5, 6) i tenzionom pneumotoraksu (7). U kardiološkoj praksi analizi ovog odvoda ne poklanja se dovoljna pažnja. Promene u smislu recipročne depresije ST segmenta i elevacije PR segmenta u odnosu na ostale odvode opisane su u u akutnom perikarditisu (8, 9), dok je morfologija P talasa opisana kao značajna u razlikovanju atrijalnih tahikardija (10, 11). Pažljivija interpretacija aVR odvoda može da pomogne u dijagnostici akutne okluzije glavnog stabla leve koronarne arterije (LMCA) ili okluzije proksimalnog segmenta prednje silazne arterije (RIA), i na taj način utiče na vreme i vrstu terapije, ali i da ukaže na prognozu kod bolesnika sa akutnim infarktom miokarda (12, 13).Odvod aVR je pojačani unipolarni električni odvod sa desne ruke za koji se smatra da gleda u šupljinu srca s desnog ramena. Ovaj odvod ima vektor u frontalnoj ravni od -150º, koji direktno gleda u gornju desnu stranu srca i obezbeđuje specifične informacije, koje se odnose na izlazni trakt desne komore i bazalni deo interventrikularnog septuma ispod aortnog i pulmonalnog zalistka. Kroz šupljinu leve komore aVR odvod gleda u unutrašnju stranu apeksa i lateralnog zida i direktno se električno suprotstavlja standardnim odvodima DI, DII, aVL i prekordijalnim odvodima V4-V6. U praksi, većina kliničara smatra da aVR odvod daje recipročne informacije iz leve lateralne strane, koja je već pokrivena odvodima aVL, V4-V6. To je razlog za zanemarivanje aVR odvoda (14).Bazalni deo interventrikularnog septuma ishranjuje se najčešće iz septalnih grana proksimalnog dela RIA, a u slučaju njene okluzije, taj deo interventrikularnog septuma ishranjuje se iz heterokolateralne cirkulacije zadnje interventrikularne grane desne koronarne arterije. Transmuralni infarkt miokarda ove regije obično uzrokuje ST elevaciju u aVR odvodu (15, 16). DIJAGNOSTIČKI I PROGNOSTIČKI ZNAČAJ -REZULTATI ISTRAŽIVANJA

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Uncommon electrocardiographic changes corresponding to symptoms during recurrent pulmonary embolism as documented by computed tomography scans

Watanabe¹,

Kikushima²,

Tanno³

et al. 1998

Clinical Cardiology

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Summary: Electocardiographic (ECG) findings of pulmonary embolism (PE) include S I Q~T~ pattern, right bundlebranch block, right-axis deviation, and T-wave inversion in medial precordial leads. We report other uncommon ECG changes associated with various symptoms during recurrent PE as documented by computed tomography (CT) scans in a single patient. An 83-year-old woman was admitted with PE secondary to deep venous thrombosis in the left leg. During episodes of chest pain. ECG showed QTc prolongation (480 Ins) with new T-wave inversion in leads 111, aVF, and VI-V~, and ST-segment depression in leads VS-v6. Despite adequate anticoagulant therapy, recurrent episodes of PE occurred in the hospital. When the patient experienced sudden chest tightness, ECG showed a new S-wave notch in lead V I and clockwise rotation with sinus tachycardia. She also experienced transient syncope with hypotension. At this time, ECG showed transient atrioventricularjunctional rhythm followed by sinus arrest. and CT scan showed a new massive embolus in the main pulmonary trunk with right ventricular dilatation, as demonstrated by echocardiography. The mechanism responsible for QTc prolongation with ST-T changes, the S-wave notch in lead V I with clockwise rotation, or atrioventricular junctional rhythm with sinus arrest during PE may be associated with myocardial ischemia, acute right ventricular overload, or vagal retlex, respectively.

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Electrocardiographic responses to pulmonary embolism

Cited by 29 publications

References 16 publications

Prognostic Significance of Inverted T Waves in Patients With Acute Pulmonary Embolism

Prognostic Significance of Inverted T Waves in Patients With Acute Pulmonary Embolism

10.5937/mckg48-4068 = Diagnostic and prognostic utility of aVR lead in electrocardiogram

Uncommon electrocardiographic changes corresponding to symptoms during recurrent pulmonary embolism as documented by computed tomography scans

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