Electrocardiogram patterns during hemodynamic instability in patients with acute pulmonary embolism
Zhong-qun Zhan1, Chong-quan Wang, Kjell C Nikus
1Department of Cardiology, Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan City, Hubei Province, China.
Summary
Electrocardiogram (ECG) changes in acute pulmonary embolism indicate myocardial ischemia and right ventricular strain during hemodynamic instability. New ischemic patterns emerge with clinical deterioration, aiding diagnosis.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Pulmonary Medicine
Background:
- Previous studies identified specific electrocardiogram (ECG) findings for massive pulmonary embolism.
- However, ECG patterns during hemodynamic instability in acute pulmonary embolism remain incompletely described.
Purpose of the Study:
- To compare ECG findings at baseline and during hemodynamic instability in patients with acute pulmonary embolism.
- To identify specific ECG patterns associated with clinical deterioration and hemodynamic compromise.
Main Methods:
- A comparative analysis of ECGs from twenty patients with acute pulmonary embolism.
- ECGs were recorded at baseline and during episodes of hemodynamic instability.
Main Results:
- Three distinct ischemic ECG patterns were observed during hemodynamic instability: ST-segment elevation in aVR with depression in I, V4-V6; ST-segment elevation in V1-V3/V4; and ST-segment elevation in III and/or V1/V2 with depression in V4/V5-V6.
- Ischemic ECG patterns, including S1Q3 and abnormal QRS in V1, were significantly more prevalent during instability (90%) versus baseline (5%) (P=0.001).
Conclusions:
- Hemodynamic instability in acute pulmonary embolism is characterized by ECG signs of myocardial ischemia.
- These ischemic changes are accompanied by evidence of right ventricular strain on the 12-lead ECG.
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