title: ECG Case of the Month: ECG in a 20-Year-Old Woman with Dyspnea. Sinus tachycardia (104 beats/minute), slight right axis deviation of the QRS (+92°), an R/S ratio greater than 1 in lead V1 with ST depression and T wave inversion in leads V1 - V4, and a prominent S wave in lead I, Q wave in lead III, and inverted T wave in lead III(S1 Q3 T3). These findings suggest right ventricular hypertrophy or strain and are consistent with pulmonary emboli.
abstract: A 20-year-old Hispanic woman presented to the emergency department complaining of six months of progressive dyspnea on exertion associated with intermittent palpitations. Her only past medical history was a stillbirth at 32 weeks gestation about two years ago. Her vital signs in the emergency department were a heart rate of 120 beats/minute, a blood pressure of 145/86 mmHg, and an arterial oxygen saturation of 98 percent with her breathing air. Significant laboratory values included a blood hemoglobin of 14.5 gm/dL, a hematocrit of 49 percent, a brain naturetic peptide (BNP) level of 177 pg/mL, a D-dimer level of 330 ng/ml, a prothrombin time of 12.85 s with an INR of 1.2, and a partial thromboplastin time of 45.7s. Urine pregnancy test was positive, and serum beta-human chorionic gonadotropin level was 81 MIU/mL consistent with a fetus of 3-4 weeks gestational age. An electrocardiogram was recorded.
authors.affiliation: House Officer, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans.
authors.forename: Viral N
authors.initials: VN
authors.lastname: Lathia
authors.affiliation: House Officer, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans.
authors.forename: John R
authors.initials: JR
authors.lastname: Haas
authors.affiliation: Faculty, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans.
authors.forename: Vijayendra R
authors.initials: VR
authors.lastname: Jaligam
authors.affiliation: Resident in the Department of Cardiology at Mt. Sinai Medical Center in Queens, New York.
authors.forename: Carl T
authors.initials: CT
authors.lastname: Mickman
authors.affiliation: Faculty, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans.
authors.forename: Betty P
authors.initials: BP
authors.lastname: Lo
authors.affiliation: Faculty, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans.
authors.forename: D Luke
authors.initials: DL
authors.lastname: Glancy
mesh_terms: D000328:Adult; D006332:Cardiomegaly / Q000209:etiology / Q000503:physiopathology*; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology / Q000503:physiopathology*; D011655:Pulmonary Embolism / Q000150:complications / Q000503:physiopathology*; D013616:Tachycardia, Sinus / Q000209:etiology / Q000503:physiopathology*