Pulmonary embolism electrocardiogram: Difference between revisions
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{{Pulmonary embolism}} | {{Pulmonary embolism}} | ||
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==Overview== | ==Overview== | ||
ECG abnormalities exist in both patients with and without PE who do not have preexisting cardiovascular disease thus limiting it's diagnostic usefulness.<ref name="pmid15863641">{{cite journal| author=Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides SV| title=Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. | journal=Eur Respir J | year= 2005 | volume= 25 | issue= 5 | pages= 843-8 | pmid=15863641 |doi=10.1183/09031936.05.00119704| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15863641 }} </ref><ref name="pmid11018210">{{cite journal| author=Rodger M, Makropoulos D, Turek M, Quevillon J, Raymond F, Rasuli P et al.| title=Diagnostic value of the electrocardiogram in suspected pulmonary embolism. |journal=Am J Cardiol | year= 2000 | volume= 86 | issue= 7 | pages= 807-9, A10 |pmid=11018210 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11018210 }}</ref> ECG findings may be normal as well. | ECG abnormalities exist in both patients with and without PE who do not have preexisting cardiovascular disease thus limiting it's diagnostic usefulness.<ref name="pmid15863641">{{cite journal| author=Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides SV| title=Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. | journal=Eur Respir J | year= 2005 | volume= 25 | issue= 5 | pages= 843-8 | pmid=15863641 |doi=10.1183/09031936.05.00119704| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15863641 }} </ref><ref name="pmid11018210">{{cite journal| author=Rodger M, Makropoulos D, Turek M, Quevillon J, Raymond F, Rasuli P et al.| title=Diagnostic value of the electrocardiogram in suspected pulmonary embolism. |journal=Am J Cardiol | year= 2000 | volume= 86 | issue= 7 | pages= 807-9, A10 |pmid=11018210 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11018210 }}</ref> ECG findings may be normal as well. | ||
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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
ECG abnormalities exist in both patients with and without PE who do not have preexisting cardiovascular disease thus limiting it's diagnostic usefulness.[1][2] ECG findings may be normal as well. A prospective study, reported 70% of acute PE patients to have ECG abnormalities, most commonly nonspecific ST-segment and T-wave changes.[3]
Electrocardiogram
An electrocardiogram (ECG) is routinely done on patients with chest pain to rule-out myocardial infarctions (heart attacks).
- The most common ECG finding is anterior T-wave inversion.[4]
- This likely represents reciprocal changes reflecting infero-posterior ischemia due to compression of the right coronary artery (RCA) as a result of pressure overload in the right ventricle (RV).
- Sinus tachycardia, right bundle branch block (RBBB) are also frequently seen, but again are not sensitive or specific.
- An ECG may show signs of right heart strain or acute cor pulmonale in cases of large PEs - the classic signs are a large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III (S1Q3T3).[5][6] This is present in upto 20% patient, but may also occur in other acute lung conditions and has therefore limited diagnostic value.
The most common sign, seen in the ECG tracing of a PE patient is sinus tachycardia, but it lacks specificity.[7]
The presence of Q waves in anterior leads wih coved ST-elevation after PE has also been described in few case reports.[8]
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ECG of a patient with pulmonary embolism Image courtesy of ecgpedia
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Another example; a patient with pulmonary embolism. Note the tachycardia and right axis.Image courtesy of ecgpedia
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Pulmonary embolism. S1-Q3 and signs of right frontal axis are shown. Image courtesy of Dr Jose Ganseman Dr Ganseman's webpage: An ultimate source of EKG
Prognostic Assessment
ECG findings associated with poor prognosis are:[4]
- Atrial arrhythmias
- Right bundle branch block
- Inferior Q-waves
- Precordial T-wave inversion and ST-segment changes.
- Development of QR wave in lead V1 is identified as an independent risk factor for an adverse prognosis.[9]
References
- ↑ Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides SV (2005). "Prognostic value of the ECG on admission in patients with acute major pulmonary embolism". Eur Respir J. 25 (5): 843–8. doi:10.1183/09031936.05.00119704. PMID 15863641.
- ↑ Rodger M, Makropoulos D, Turek M, Quevillon J, Raymond F, Rasuli P; et al. (2000). "Diagnostic value of the electrocardiogram in suspected pulmonary embolism". Am J Cardiol. 86 (7): 807–9, A10. PMID 11018210.
- ↑ Stein PD, Saltzman HA, Weg JG (1991). "Clinical characteristics of patients with acute pulmonary embolism". Am J Cardiol. 68 (17): 1723–4. PMID 1746481.
- ↑ 4.0 4.1 Ferrari E, Imbert A, Chevalier T, Mihoubi A, Morand P, Baudouy M (1997). "The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads--80 case reports". Chest. 111 (3): 537–43. PMID 9118684. Retrieved 2011-12-05. Unknown parameter
|month=ignored (help) - ↑ McGinn S, White PD. Acute cor pulmonale resulting from pulmonary embolism. J Am Med Assoc 1935;104:1473–1480.
- ↑ Panos RJ, Barish RA, Whye DW, Groleau G (1988). "The electrocardiographic manifestations of pulmonary embolism". J Emerg Med. 6 (4): 301–7. PMID 3225435.
- ↑ Abecasis J, Monge J, Alberca D, Grenho MF, Arroja I, Aleixo AM (2008). "Electrocardiographic presentation of massive and submassive pulmonary embolism". Rev Port Cardiol. 27 (5): 591–610. PMID 18717213.
- ↑ Raghav KP, Makkuni P, Figueredo VM (2011). "A review of electrocardiography in pulmonary embolism: recognizing pulmonary embolus masquerading as ST-elevation myocardial infarction". Rev Cardiovasc Med. 12 (3): 157–63. PMID 22145193.
|access-date=requires|url=(help) - ↑ Kucher N, Walpoth N, Wustmann K, Noveanu M, Gertsch M (2003). "QR in V1--an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism". European Heart Journal. 24 (12): 1113–9. PMID 12804925. Retrieved 2011-12-05. Unknown parameter
|month=ignored (help)