ECG Changes in Pulmonary Embolism

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ECG changes in Pulmonary Embolism

Introduction
- ECG changes in pulmonary embolism are not specific and can occur in other conditions causing acute pulmonary hypertension.
- Hypoxia leading to pulmonary hypoxic vasoconstriction can also produce similar ECG findings.
- ECG findings should always be interpreted alongside clinical presentation and diagnostic tests.

Common ECG Abnormalities
- Sinus tachycardia (heart rate above 100 beats per minute) is present in approximately 44% of patients with pulmonary embolism.
- Right bundle branch block (complete or incomplete) is observed in 18% of patients and is associated with increased mortality.

Right Ventricular Strain Pattern
- T wave inversions in right precordial leads (V1-V4) and inferior leads (II, III, aVF) indicate high pulmonary artery pressures.
- This pattern is seen in up to 34% of patients with pulmonary embolism.
- Right axis deviation occurs in 16% of cases; extreme deviation may mimic left axis deviation ("pseudo left axis").

Additional ECG Findings
- A dominant R wave in V1 reflects acute right ventricular dilatation.
- Right atrial enlargement (P pulmonale) is characterized by a peaked P wave in lead II (more than 2.5 mm) and is seen in 9% of patients.

Specific ECG Patterns
- The S1Q3T3 pattern (deep S wave in lead I, Q wave in lead III, inverted T wave in lead III) is found in only 20% of cases and is not sensitive or specific.
- Clockwise rotation (R/S transition shift towards V6 with persistent S wave in V6) suggests right ventricular dilatation.

Atrial Arrhythmias and Non-Specific Changes
- Atrial tachyarrhythmias (atrial fibrillation, atrial flutter, atrial tachycardia) are observed in 8% of patients.
- Non-specific ST segment and T wave changes (e.g., ST elevation or depression) are reported in up to 50% of patients.

Highly Specific ECG Finding
- Simultaneous T wave inversions in inferior leads (II, III, aVF) and right precordial leads (V1-V4) have a specificity of up to 99% for pulmonary embolism.

Conclusion
- ECG abnormalities in pulmonary embolism are valuable but not diagnostic on their own.
- These findings should be interpreted alongside clinical presentation, risk factors, and other diagnostic tests.
- Recognizing these patterns is essential for timely diagnosis and management of this potentially life-threatening condition.
Category
Cardiology
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