11/5/2023 0 Comments Ecg changes in peThe S1Q3T3 pattern was first described by McGinn and White in 1935. Usual positive findings on ECG include sinus tachycardia, the classic S1Q3T3 pattern (as seen in our case), anterior T-wave inversions, signs of right ventricular hypertrophy or right atrial enlargement, transient right bundle branch block, right axis deviation of the frontal QRS axis, leftward shift in the transition zone in the precordial leads, and new-onset atrial arrhythmias. It is known that the ECG in itself is a poor diagnostic tool for establishing the diagnosis of PE since often it may be normal or show only nonspecific findings. These ECG signs included the presence of the S1Q3T3 pattern, rightward axis (+90) and S waves in V6 suggestive of the right ventricular overload the anterior precordial T inversions were, in fact, a manifestation of acute right ventricular strain. However, careful analysis of the ECG revealed that though there were ST depression and T inversion in anterior precordial leads (suggesting anterior NSTEMI), there were other clues to an alternative diagnosis, namely PE. The ECG pattern of anterior precordial leads’ T-wave inversion and elevated troponin levels probably prompted the referral diagnosis of ACS. This case was initially diagnosed and managed as ACS and subsequently referred to our institution for a coronary angiogram. Īcute PE most often presents with sudden onset chest pain or shortness of breath and can be potentially fatal, if not diagnosed and treated in time. A 64-slice spiral computed tomography (CT) scan was performed which revealed submassive PE and thrombotic obstruction of segmental and subsegmental left and right branch pulmonary arteries, confirming the diagnosis of acute PE. The left ventricular (LV) function was normal. There was moderate tricuspid regurgitation (TR) and an estimated RV systolic pressure of 90 mmHg. This revealed dilated right atrium, mildly dilated (right ventricle ) which was hypokinetic with moderately depressed ejection fraction. The mode of presentation and these additional ECG findings led to a presumptive diagnosis of acute PE, and a two-dimensional echocardiography was performed. A closer look at the ECG revealed that in addition to the anterior precordial ST depression, there was evidence of S1Q3T3 pattern (prominent S wave in the lead I, presence of Q and inverted T wave in the lead III), ST-segment depression in inferior leads and R/S in V6 <1. Chest and cardiovascular examination was unremarkable, without any evidence of heart failure or pulmonary congestion. On presentation at our institution, she was dyspneic, with a respiratory rate 26/min and blood pressure of 110/70 mmHg. ![]() Twelve lead electrocardiogram showing the anterior precordial ST depression, S1Q3T3 pattern, ST segment depression in inferior leads and R/S in V6 <1
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