The electrocardiogram in acute pulmonary embolism

Exploratory insights from the right‐sided electrocardiogram following prolonged endurance exercise

“…There was a significant increase in P wave amplitude in lead II from pre to post-race in the current study and although the value does not reach the criteria for P pulmonale (Stein et al, 1975;Stein et al, 1991), this may be indicative of right atrial (RA) enlargement or restrictive filling in the presence of an acute pressure/volume overload on the RA (Stein et al, 1991). Interestingly, P pulmonale has been reported in cases where an acute afterload is placed on the right side of the heart and the increase in P wave amplitude in the current study may therefore indicate a manifestation of the transient elevation in the pulmonary artery pressures previously reported following ultra-endurance exercise (Kovacs et al, 2009;La Gerche et al, 2011).…”

Diagnosis of pulmonary embolism in the coronary care unit

“…4 Atrial flutter or atrial fibrillation in patients with acute PE is infrequent in patients with no prior heart disease. 22 Abnormalities of the ST segment and T wave are by the most frequent electrocardiographic manifestation of PE. 4,22 Electrocardiographic manifestations of acute cor pulmonale (S 1 Q 3 T 3 , complete right bundle branch block, P pulmonale, or right axis deviation) occurred in 26% to 32% of patients with submassive or massive acute PE who did not have associated cardiac or pulmonary disease.…”

“…22 Abnormalities of the ST segment and T wave are by the most frequent electrocardiographic manifestation of PE. 4,22 Electrocardiographic manifestations of acute cor pulmonale (S 1 Q 3 T 3 , complete right bundle branch block, P pulmonale, or right axis deviation) occurred in 26% to 32% of patients with submassive or massive acute PE who did not have associated cardiac or pulmonary disease. 22 The problem of distinguishing the prominent Q waves known to occur with PE from those of myocardial infarction has been recognized for many years.…”

“…22 The problem of distinguishing the prominent Q waves known to occur with PE from those of myocardial infarction has been recognized for many years. 22 The electrocardiogram may simulate infarction in any-region of the heart. 22 Leftward shifts of the frontal plane axis in PE are frequent in acute PEand were observed more frequently than a rightward shift.…”

“…22 The electrocardiogram may simulate infarction in any-region of the heart. 22 Leftward shifts of the frontal plane axis in PE are frequent in acute PEand were observed more frequently than a rightward shift. 23 Low voltage frontal plane QRS complexes may be a sign of acute PE 22 although it is uncommon.…”