title: Inverted T waves on electrocardiogram: myocardial ischemia versus pulmonary embolism.
abstract: Electrocardiogram (ECG) is of limited diagnostic value in patients suspected with pulmonary embolism (PE). However, recent studies suggest that inverted T waves in the precordial leads are the most frequent ECG sign of massive PE (Chest 1997;11:537). Besides, this ECG sign was also associated with the best sensitivity, specificity, and positive and negative predictive values for diagnosing PE. We report 2 cases with similar ECG findings that were referred to us as unstable angina. Both were hemodynamically stable and had moderate-size pulmonary emboli. The ECG findings reverted to normal within a week of anticoagulation treatment. Our observation suggests that even a moderate-size PE can cause these ECG changes.
authors.affiliation: Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sarin
authors.forename: Farhad
authors.initials: F
authors.lastname: Elmi
authors.forename: Louis
authors.initials: L
authors.lastname: Nassef
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011655:Pulmonary Embolism / Q000175:diagnosis*