Electrocardiographic features in critical pulmonary embolism. Results from baseline and continuous electrocardiographic monitoring.

BACKGROUND

Pulmonary embolism (PE) afflicts millions of individuals worldwide. Electrocardiography along with chest X-ray and arterial blood gas analysis represent the basic examinations to reinforce the clinical suspicion of PE. We describe the electrocardiographic (ECG) features in a series of patients with PE and a critical clinical presentation.

METHODS

We report the ECG findings registered at baseline, 48 hours after admission and on continuous ECG monitoring in 51 patients with PE and critical clinical conditions.

RESULTS

At admission, the following parameters were recorded: an S1Q3 pattern in 34 patients, a "septal embolic pattern" in 27, anterior lead T-wave inversion in 8, and a new right bundle branch block in 7. At 48 hours after admission a trend toward a regression of the S1Q3 and "septal embolic" patterns was noted together with evident T-wave inversion in the anterior leads. During continuous ECG monitoring no major arrhythmias were recorded, even in case of cardiopulmonary arrest.

CONCLUSIONS

Critical PE induces transient ECG abnormalities reflecting right ventricular overload and/or strain. The patient's clinical status is usually not complicated by major ventricular arrhythmias, not even in case of cardiopulmonary arrest.