![pe ecg findings pe ecg findings](https://pmj.bmj.com/content/postgradmedj/95/1119/12/F1.large.jpg)
So, in addition to the sinus tachycardia with deep, symmetric T wave inversion in BOTH of the RV distributions (ie, both in inferior as well as anterior leads) - there is: i) RAA (tall, peaked and pointed P waves in each of the inferior leads) ii) an SI,SII,SIII pattern (one usually does not see S waves in all 3 standard leads) and iii) persistence of S waves all the way to V6 (lateral chest lead S waves are relatively uncommon).
#Pe ecg findings series
First - I’d emphasize the thought that rather than any single ECG finding - RVH patterns (including acute RV “strain”) are what I call the “Detective Diagnosis” - in that there is no single ECG finding that is absolutely diagnostic - but instead, there is a series of clues, that like a good “detective story” when put together lead to strong suggestion of the clinical diagnosis. GREAT case with (as per the title) - an ECG pattern that MUST be recognized! I’d add the following comments regarding ECG signs suggestive of acute right heart strain (therefore acute PE given the clinical scenario here). The T-waves simply look different in Wellens'. When there is tachycardia, the patient is in cardiogenic shock with very poor LV function on bedside echo.ģ. Acute coronary occlusion (especially during reperfusion) is very rarely accompanied by tachycardia. In this case we have a crashing patient while T-wave inversion is ongoing!Ģ. Coronary reperfusion changes on ECG should be accompanied by significant reduction or resolution of symptoms. Wellens' is a syndrome of a painless period following an anginal (chest pain) event. Thus, it is critical to compare the ECG with the symptomatic state of the patient!ĭifferences of Pulmonary Embolism T-waves from Wellens' T-waves:ġ. However, in reperfusion (Wellens'), the symptoms are resolved at the time of the ECG. It is also true that anterior and inferior T-wave inversion could be consistent with reperfusion of a type III wraparound LAD occlusion, despite the fact that Kosuge et al showed that T-wave inversion in lead III is much more likely to be PE than ACS if your differential contains nothing else. It is true that the morphology of the T-wave inversions can be very similar in anterior reperfusion syndrome (Wellens). The best answer is because the entire gestalt of the ECG shows acute right heart strain instead, and just does not look like Wellens after you've seen Wellens hundreds of times. Why is it not Wellens? (Wellens pattern is a term which refers to coronary reperfusion morphology in the anterior leads) The findings include sinus tachycardia, characteristic QRS morphology most diagnostic in V3 with a small R wave followed by a very large S wave with a convex upward ST segment morphology, ST segment strain morphology in the inferior and anterior leads leading to deep symmetric T-wave inversion. It has even been seen anecdotally in acute cessation or discontinuation of continuous IV pulmonary vasodilator. This includes, but is not limited to, PE, asthma/COPD exacerbation, hypoxic vasoconstriction from pneumonia, acute pulmonary hypertension exacerbation. Notice I did not say "pulmonary embolism," because any form of severe acute right heart strain may produce this ECG.
![pe ecg findings pe ecg findings](https://angiologist.com/wp-content/uploads/2011/03/ECGPE.png)
![pe ecg findings pe ecg findings](https://3.bp.blogspot.com/-6zrX1mFfeC0/UdUTxBgZEaI/AAAAAAAAAdY/ssMbD5cyRrE/s1600/ECG226.jpg)
This ECG is diagnostic of hemodynamically significant acute right heart strain. Let's consider this nearly pathognomonic ECG without the clinical context (because sometimes the clinical context will not be as easy as in this case). Written by Pendell Meyers, with edits from Steve Smith