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Related Experiment Videos

The electrocardiogram in acute pulmonary embolism.

P D Stein, J E Dalen, K M McIntyre

    Progress in Cardiovascular Diseases
    |January 1, 1975
    PubMed
    Summary

    Electrocardiogram (ECG) findings in acute pulmonary embolism are often nonspecific. Traditional signs of acute cor pulmonale are infrequent, highlighting the need for broader diagnostic considerations beyond these specific ECG abnormalities.

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    Area of Science:

    • Cardiology
    • Pulmonary Medicine
    • Diagnostic Imaging

    Background:

    • Acute pulmonary embolism (PE) diagnosis relies on various methods, including electrocardiography (ECG).
    • Traditional ECG findings suggestive of acute cor pulmonale are not universally present in PE patients.
    • Understanding the spectrum of ECG abnormalities in PE is crucial for accurate diagnosis.

    Purpose of the Study:

    • To investigate the range and frequency of electrocardiographic abnormalities in patients with acute submassive or massive pulmonary embolism.
    • To assess the diagnostic utility of traditional acute cor pulmonale signs on ECG in PE.
    • To correlate ECG findings with hemodynamic parameters and lung scan/arteriogram data in PE.

    Main Methods:

    • Retrospective analysis of electrocardiograms from 90 patients with documented acute pulmonary embolism.

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  • Patients were selected from the Urokinase-Pulmonary Embolism Trial National Cooperative Study.
  • ECG findings were correlated with clinical data, including pulmonary embolism severity, hemodynamic measurements, and imaging results.

    • Main Results:

    • A significant percentage of patients with acute pulmonary embolism had normal or nonspecific ECG findings (e.g., T wave and RST segment changes).
    • Traditional signs of acute cor pulmonale (S1Q3T3, right bundle branch block, P pulmonale, right axis deviation) were present in only 26% of patients.
    • Left axis deviation and low voltage QRS complexes were observed, with T wave inversion being the most persistent abnormality.
    • Larger pulmonary embolism defects and higher pulmonary arterial pressures correlated with ECG abnormalities.

    Conclusions:

    • Electrocardiography in acute pulmonary embolism often reveals nonspecific changes, and traditional signs of acute cor pulmonale are not consistently present.
    • Reliance solely on classic ECG abnormalities can lead to missed diagnoses of pulmonary embolism.
    • Acute ventricular dilatation, potentially exacerbated by hypoxemia, is suggested as a cause of ECG changes in acute PE.