Syncope with QT‐interval prolongation and T‐wave inversion in anterior and inferior leads: Foreboder of a life‐threatening condition?

Abstract

A 60-year-old patient with syncope for 1 day presented to the emergency department of the First Affiliated Hospital of USTC. He had a history of hypertension for 6 months, which was well-controlled on medication. There was no family history of sudden cardiac death.Physical examination revealed a heart rate of 62 beats/min and a blood pressure of 117/74 mmHg. All vital signs were within the normal limits. An electrocardiogram (ECG) on admission is shown in Figure 1. Laboratory results (hemogram, renal and hepatic function tests, and troponin I, antineutrophil cytoplasmic antibody, antiphospholipid antibody, serum sodium, potassium, magnesium, and calcium levels) were all within normal limits. However, D-dimer levels were significantly elevated to 5.07 mg/L (reference value, <0.5 mg/L).There were no signs of peripheral edema or neurological dysfunction. Echocardiography revealed right ventricular enlargement (44 mm) with mild pulmonary hypertension (systolic pulmonary artery pressure, 46 mmHg). Venous Doppler ultrasonography was negative for deep venous thrombosis. His peripheral oxygen saturation fluctuated between 95 and 96% on room air. The patient underwent computed tomography-pulmonary angiography, which revealed pulmonary embolism (PE) (Figure 2). He was anticoagulated with low-molecular-weight heparin and warfarin for 7 days. Repeat ECG showed that the QT interval had shortened to 432 ms (Figure 3). The patient recovered favorably, and was discharged from the hospital.Several typical ECG changes are associated with PE, including P pulmonale, right axis deviation, S1S2S3 pattern, low voltage, clockwise rotation, right bundle-branch block, S1Q3T3 pattern, arrhythmia, nonspecific ST-segment changes, QR pattern in lead V1,