title: Value of the 12-lead electrocardiogram at hospital admission in the diagnosis of pulmonary embolism.
abstract: In 49 consecutive patients (27 men and 22 women, age range 44 to 86 years) presenting with acute symptoms and with subsequently proven pulmonary embolism, and without previous lung disease, the 12-lead electrocardiograms obtained at hospital admission were reviewed in a blinded fashion to identify electrocardiographic features suggestive of right ventricular overload. Pulmonary embolism was considered probable in 37 patients (76%), from the presence of > or = 3 of the following abnormalities: (1) incomplete or complete right bundle branch block (n = 33); which was associated with ST-segment elevation (n = 17) and positive T wave (n = 3) in lead V1; (2) S waves in leads I and aVL of > 1.5 mm (n = 36); (3) a shift in the transition zone in the precordial leads to V5 (n = 25); (4) Q waves in leads III and aVF, but not in lead II (n = 24); (5) right-axis deviation, with a frontal QRS axis of > 90 degrees (n = 16), or an indeterminate axis (n = 15); (6) a low-voltage QRS complex of < 5 mm in the limb leads (n = 10); and (7) T-wave inversion in leads III and aVF (n = 16) or leads V1 to V4 (n = 13), which occurred more often in patients with symptoms for > 7 days. In the 12 patients with normal electrocardiograms at admission, serial electrocardiograms revealed diagnostic features of embolism in an additional 3 patients. Two-dimensional Doppler echocardiography at admission revealed tricuspid valve regurgitation and an increased right ventricular end-diastolic diameter in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Sreeram
authors.forename: E C
authors.initials: EC
authors.lastname: Cheriex
authors.forename: J L
authors.initials: JL
authors.lastname: Smeets
authors.forename: A P
authors.initials: AP
authors.lastname: Gorgels
authors.forename: H J
authors.initials: HJ
authors.lastname: Wellens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies