Open AccessUncommon electrocardiographic changes corresponding to symptoms during recurrent pulmonary embolism as documented by computed tomography scans
Author(s) -
Watanabe Takuya,
Kikushima Shuji,
Tanno Kaoru,
Geshi Eiichi,
Kobayashi Youichi,
Takeyama Youichi,
Katagiri Takashi
Publication year - 1998
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960211117
Subject(s) - medicine , cardiology , sinus tachycardia , pulmonary embolism , t wave , sinus rhythm , electrocardiography , st depression , chest pain , junctional rhythm , st segment , anesthesia , atrial fibrillation , myocardial infarction
Electocardiographic (ECG) findings of pulmonary embolism (PE) include S 1 Q 3 T 3 pattern, right bundlebranch block, right‐axis deviation, and T‐wave inversion in medial precordial leads. We report other uncommon ECG changes associated with various symptoms during recurrent PE as documented by computed tomography (CT) scans in a single patient. An 83‐year‐old woman was admitted with PE secondary to deep venous thrombosis in the left leg. During episodes of chest pain, ECG showed QTc prolongation (480 ms) with new T‐wave inversion in leads III, aVF, and V 1 ‐V 3 , and ST‐segment depression in leads V 5 ‐V 6 . Despite adequate anticoagulant therapy, recurrent episodes of PE occurred in the hospital. When the patient experienced sudden chest tightness, ECG showed a new S‐wave notch in lead V 1 and clockwise rotation with sinus tachycardia. She also experienced transient syncope with hypotension. At this time, ECG showed transient atrioventricular junctional rhythm followed by sinus arrest, and CT scan showed a new massive embolus in the main pulmonary trunk with right ventricular dilatation, as demonstrated by echocardiography. The mechanism responsible for QTc prolongation with ST‐T changes, the S‐wave notch in lead V 1 with clockwise rotation, or atrioventricular junctional rhythm with sinus arrest during PE may be associated with myocardial ischemia, acute right ventricular overload, or vagal reflex, respectively.