title: Electrocardiogram patterns during hemodynamic instability in patients with acute pulmonary embolism.
abstract: BACKGROUND
  We have previously described new electrocardiogram (ECG) findings for massive pulmonary embolism, namely ST-segment elevation in lead aVR with ST-segment depression in leads I and V4 -V6 . However, the ECG patterns of patients with acute pulmonary embolism during hemodynamic instability are not fully described.
  
  
  METHODS
  We compared the differences between the ECG at baseline and after deterioration during hemodynamic instability in twenty patients with acute pulmonary embolism.
  
  
  RESULTS
  Compared with the ECG at baseline, three ischemic ECG patterns were found during clinical deterioration with hemodynamic instability: ST-segment elevation in lead aVR with concomitant ST-segment depression in leads I and V4 -V6 , ST-segment elevation in leads V1 -V3 /V4 , and ST-segment elevation in leads III and/or V1 /V2 with concomitant ST-segment depression in leads V4 /V5 -V6 . Ischemic ECG patterns with concomitant S1Q3 and/or abnormal QRS morphology in lead V1 were more common (90%) during hemodynamic instability than at baseline (5%) (P = 0.001).
  
  
  CONCLUSIONS
  Hemodynamic instability in acute pulmonary embolism is reflected by signs of myocardial ischemia combined with the right ventricular strain pattern in the 12-lead ECG.
authors.affiliation: Department of Cardiology, Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan City, Hubei Province, China.
authors.forename: Zhong-qun
authors.initials: ZQ
authors.lastname: Zhan
authors.forename: Chong-quan
authors.initials: CQ
authors.lastname: Wang
authors.forename: Kjell C
authors.initials: KC
authors.lastname: Nikus
authors.forename: Chao-rong
authors.initials: CR
authors.lastname: He
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Shan
authors.initials: S
authors.lastname: Mao
authors.forename: Xiong-jian
authors.initials: XJ
authors.lastname: Dong
mesh_terms: D000208:Acute Disease; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D011655:Pulmonary Embolism / Q000150:complications / Q000503:physiopathology*; D012770:Shock, Cardiogenic / Q000150:complications / Q000503:physiopathology*
keywords: acute pulmonary embolism; electrocardiogram; hemodynamic instability; myocardial ischemia; right ventricular strain
references.citation: Kardiol Pol. 2011;69(7):649-54
references.pmid: 21769779
references.citation: Am J Emerg Med. 2002 May;20(3):252-62
references.pmid: 11992349
references.citation: Ann Noninvasive Electrocardiol. 2014 Jul;19(4):398-405
references.pmid: 24206526
references.citation: Am J Cardiol. 2009 Mar 15;103(6):881-6
references.pmid: 19268750
references.citation: Am J Med. 2009 Mar;122(3):257-64
references.pmid: 19272487
references.citation: Ann Noninvasive Electrocardiol. 2014 May;19(3):234-40
references.pmid: 24118140
references.citation: J Electrocardiol. 2001 Jul;34(3):185-8
references.pmid: 11455507
references.citation: Int J Cardiol. 2007 Mar 20;116(2):e57-9
references.pmid: 17088001
references.citation: Am J Med Sci. 2010 Oct;340(4):326-8
references.pmid: 20827172
references.citation: Eur Heart J. 2008 Sep;29(18):2276-315
references.pmid: 18757870
references.citation: Am J Cardiol. 2007 Mar 15;99(6):817-21
references.pmid: 17350373
references.citation: Nat Clin Pract Cardiovasc Med. 2006 Nov;3(11):633-6
references.pmid: 17063168
references.citation: Chest. 1970 Sep;58(3):205-12
references.pmid: 4248170
references.citation: Eur Heart J. 2003 Jun;24(12):1113-9
references.pmid: 12804925
references.citation: J Am Osteopath Assoc. 2008 Jul;108(7):344-9
references.pmid: 18648028
references.citation: Am J Emerg Med. 2001 Oct;19(6):514-9
references.pmid: 11593473
references.citation: Am J Emerg Med. 2013 Feb;31(2):456.e5-8
references.pmid: 23000330
references.citation: Eur Heart J Acute Cardiovasc Care. 2013 Jun;2(2):131-6
references.pmid: 24222822
references.citation: Herz. 2015 Apr;40(2):314-7
references.pmid: 24154889
references.citation: Kardiol Pol. 2011;69(3):235-40
references.pmid: 21432791
references.citation: Int J Cardiol. 1999 Dec 15;72(1):65-72
references.pmid: 10636634
references.citation: J Cardiol. 2009 Dec;54(3):503-6
references.pmid: 19944331
references.citation: Clin Cardiol. 1998 Nov;21(11):858-61
references.pmid: 9825204
references.citation: J Am Coll Cardiol. 2001 Nov 1;38(5):1355-6
references.pmid: 11691507
references.citation: Am Heart J. 2007 Jul;154(1):71-8
references.pmid: 17584554
references.citation: Cardiol J. 2011;18(6):648-53
references.pmid: 22113752
references.citation: Circ J. 2009 Jun;73(6):1157-9
references.pmid: 19096187
references.citation: BMJ Case Rep. 2011 Jul 20;2011:
references.pmid: 22689659
references.citation: Cardiovasc Ultrasound. 2010 Nov 24;8:50
references.pmid: 21106090
references.citation: Heart Vessels. 1999;14(4):197-200
references.pmid: 10776824