Pulmonary Embolism

  • The sensitivity of the ECG to diagnose PE is very low
  • The specificity of ECG signs suggestive of PE is very low
  • The ECG signs are only useful if they are not known to be old
  • The ECG may direct you to consider PE under the appropriate clinical scenario
In patients with suspected or documented PE, the presence of ECG markers suggests hemodynamically significant PE (acute cor pulmonale)
  • The most important unfavorable prognostic sign is new incomplete or complete RBBB
  • Sinus tachycardia: important “company” for all other markers
  • SI – QIII - TIII pattern: S wave in lead I >1.5 mm; Q wave and inverted T in lead III
  • Incomplete or complete RBBB: rSR’ in V1
  • T wave inversion in V1-V3: mimics anterior ischemia

Clinical SigNificance

  • It signifies hemodynamic severity
  • Poor prognosis, high mortality
  • May want to obtain stat echo
  • Consider lytics
  • Consider pressors
  • Use caution with vasodilators
    • Be careful with intubation