PULMONARY EMBOLISM: POSSIBLE ECG PATTERNS

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 PULMONARY EMBOLISM

PULMONARY EMBOLISM IS A BLOCKAGE IN ONE OF THE PULMONARY  ARTERIES IN YOUR LUNG.

OFTEN PRESENT AS A COMBINATION OF CHEST PAIN AND BREATHLESSNESS.

ALTHOUGH THE CHEST PAIN IS  CHARACTERISTICALLY ONE-SIDED AND PLEURITIC, A MAJOR EMBOLUS AFFECTING THE MAIN PULMONARY ARTERIES MAY CAUSE PAIN RESEMBLING THAT OF MYOCARDIAL INFARCTION.

PATIENT WITH PULMONARY HYPERTENSION USUALLY COMPLAIN OF BREATHLESSNESS BUT NOT PAIN.

WITH PULMONARY EMBOLISM THE MOST COMMON ECG FINDING IS SINUS TACHYCARDIA WITH NO OTHER ABNORMALITY.

SO, THE ECG IS NOT A VERY USEFUL DIAGNOSTIC TOOL, HOWEVER THE APPEARANCE OF RIGHT BUNDLE BRANCH BLOCK (OR) THE CHANGES ASSOCIATED WITH RIGHT VENTRICULAR HYPERTROPHY [ RIGHT AXIS DEVIATION, A DOMINANT R WAVE IN LEAD V1, AND T WAVE INVERSION IN LEADS V1-V3] WOULD STRONGLY SUPPORT THE DIAGNOSIS.

WHEN PULMONARY EMBOLISM SUSPECTED, LOOK FOR ANY OF THE FOLLOWING:

1. PEAKED P WAVES.

2.RIGHT AXIS DEVIATION (S WAVES IN LEAD 1).

3. TALL R WAVES IN LEAD V1.

4. RIGHT BUNDLE BRANCH BLOCK.

5. INVERTED T WAVES IN LEAD V1(NORMAL), SPREADING ACROSS TO LEAD V2 OR  V3.

6. A SHIFT OF TRANSITION POINT TO THE LEFT,SO THAT THE R WAVE EQUALS TO (S- WAVE).



NOTE: SINUS RHYTHM, RATE 75/MIN.

             RIGHT AXIS DEVIATION.

             PEAKED P WAVES, ESPECIALLY IN LEAD 2.

             PERSISTENT S WAVE IN LEAD V6.

             T WAVE INVERSION IN LEADS V1-V4.

COMMONLY QUOTED:[S1Q3T3 ] PATTERN

(RIGHT AXIS DEVIATION WITH PROMINENT (S-WAVE) IN LEAD 1 AND (Q -WAVE) AND AN INVERTED (T-WAVE) IN LEAD 3. INDICATORS OF PULMONARY EMBOLISM.

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