11/16/2023 0 Comments P rad 4![]() ![]() Kosuge M, Kimura K, Ishikawa T, Ebina T, Hibi K, Kusama I, Nakachi T, Endo M, Komura N, Umemura S.Electrocardiographic manifestations of pulmonary embolism. Ullman E, Brady WJ, Perron AD, Chan T, Mattu A.Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Rodger M, Makropoulos D, Turek M, Quevillon J, Raymond F, Rasuli P, Wells PS.Predictive value of negative T waves in precordial leads–80 case reports. ![]() Ferrari E, Imbert A, Chevalier T, Mihoubi A, Morand P, Baudouy M.In conclusion, the presence of negative T waves in both leads III and V1 allows PE to be differentiated simply but accurately from ACS in patients with negative T waves in the precordial leads. The sensitivity, specificity, positive predictive value, and negative predictive value of this finding for the diagnosis of PE were 88%, 99%, 97%, and 95%, respectively. Negative T waves in leads III and V1 were observed in only 1% of patients with ACS compared with 88% of patients with Acute PE (p less than 0.001). Kosuge et al have shown that simultaneous inversion in III and V1 are diagnostically significant:.Bedside echo may be useful in differentiating the two, demonstrating features of RV dilatation and pulmonary arterial hypertension.ACS is rarely associated with tachycardia.Both ACS and PE can present with elevated troponin, but several findings can assist in differentiating between the two: T-wave inversion is commonly associated with acute coronary syndrome (ACS). Simultaneous T wave inversions in the inferior (II, III, aVF) and right precordial leads (V1-4) is the most specific finding in favour of PE, with reported specificities of up to 99% in one study.ĮCG findings compared to Acute Coronary Syndrome Non-specific ST segment and T wave changes, including ST elevation and depression (50%).Atrial tachyarrhythmias – AF, flutter, atrial tachycardia (8%).Clockwise rotation – shift of the R/S transition point towards V6 with a persistent S wave in V6 (“pulmonary disease pattern”), implying rotation of the heart due to right ventricular dilatation.This “classic” finding is neither sensitive nor specific for PE S I Q III T III pattern – deep S wave in lead I, Q wave in III, inverted T wave in III (20%).Right atrial enlargement (P pulmonale) – peaked P wave in lead II > 2.5 mm in height (9%).Dominant R wave in V1 – a manifestation of acute right ventricular dilatation.Extreme right axis deviation may occur, with axis between zero and -90 degrees, giving the appearance of left axis deviation (“pseudo left axis”) This pattern is associated with high pulmonary artery pressures (34%) Right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF).Sinus tachycardia – the most common abnormality (seen in 44% of patients with PE). ![]()
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