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.
Costantini
Marcello
M
Division of Cardiology, S. Caterina Novella Hospital, Azienda USL LE/I, Lecce, Italy.
Bossone
Eduardo
E
Renna
Realino
R
Sticchi
Giovanni
G
Licci
Enrico
E
De Fabrizio
Giovanni
G
Li Bergolis
Maria
M
Codega
Silvia
S
Tarantino
Federica
F
Mazza
Alfredo
A
Distante
Alessandro
A
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000473:pathology; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D010343:Patient Admission; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000401:mortality; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D