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ECG of Acute Pulmonary Embolism

 Case 1. A 23-year old gentleman presented with history of chest pain and shortness of breath. 

This was the ECG at the time of presentation. 

What are the findings?

What is the diagnosis?


Answer:

ECG shows Sinus tachycardia and S1Q3T3 pattern. 

S1Q3T3 pattern is a specific sign of acute pulmonary embolism.

CTPA confirmed the diagnosis.  

Patient underwent thrombolysis with Tenecteplase successfully with resolution of symptoms.

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The patient contacts the doctor over phone with this report.   Obviously anxious because of his high heart rate (199 beats per minute) as detected by ECG machine.  Should he be worried about this and come to emergency department as soon as possible? Correct answer-  ECG machine has calculated his heart rate incorrectly.  Heart rate is around 100 beats per minute.  Other findings in this ECG include ST segment elevation in anterior chest leads along with presence of Q waves, denoting old MI changes with possibly development of LV aneurysm. In such cases, ST segment elevation can persist for long periods.    Now, should he come to emergency department? Not because of detection of high heart rate.  But, if he is having symptoms such as shortness of breath or chest pain, he should visit emergency department. Otherwise, if he is asymptomatic, he can schedule a regular visit with his cardiologist. 

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