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Diffuse ST segment elevation
0%
0/10
Low voltage
10%
1/10
Prolonged QT interval
30%
3/10
Right bundle branch block
Sinus tachycardia
50%
5/10
Select Answer to see Preferred Response
This patient with chest pain and shortness of breath has a CT angiogram of the chest demonstrating a large, proximal pulmonary embolism. The most common electrocardiogram finding in patients with pulmonary embolism is sinus tachycardia.Pulmonary embolism impedes pulmonary blood flow resulting in pulmonary hypertension and right heart strain. While sinus tachycardia is the most common electrocardiogram finding in patients with pulmonary embolism, a number of associated findings also occur. Right bundle branch block is another common finding that results from right heart strain in pulmonary embolism. Furthermore, a S wave in lead I with a Q wave and inverted T wave in lead III (e.g. S1Q3T3) pattern is commonly reported. However, this finding signifies right heart strain and, similar to a right bundle branch block pattern, is not specific to pulmonary embolism. Pulmonary hypertension or chronic lung disease such as COPD may also produce similar findings. Davidson reviewed the diagnosis and treatment of venous thromboembolism and concluded that empiric anticoagulation therapy should be considered if the best available diagnostic tests are inconclusive, given the relative safety and efficacy of anticoagulation and the potential problems confirming diagnosis.Rodger et al. found in a study of 246 patients with suspected PE that of all the potential EKG changes associated with PE. They found that sinus tachycardia was the most common electrocardiogram change with right bundle branch block also being common. Figure A demonstrates a CT angiogram image of the chest with a large, proximal pulmonary embolism. Note the large hypodensity at the branch point of the main pulmonary artery with associated filling defect. Incorrect Answers:Answer 1: Diffuse ST segment elevation is a common electrocardiogram finding in patients with pericarditis. While pericarditis may also present with chest pain and shortness of breath, this patient has CT imaging confirming the diagnosis of pulmonary embolism. Diffuse ST segment elevation is not associated with pulmonary embolism. Answer 2: Low voltage is associated with pericardial effusion, as fluid dampens the electrical amplitude detected on the electrocardiogram. While pericardial effusion may also present with chest pain and shortness of breath, this patient has CT imaging confirming the diagnosis of pulmonary embolism. Low voltage is not associated with pulmonary embolism.Answer 3: Prolonged QT interval occurs on the electrocardiogram as a result of electrolyte disturbances and medication side effects. It is not commonly associated with pulmonary embolism. Answer 4: Right bundle branch block is often seen on the electrocardiogram in patients with pulmonary embolism and associated right heart strain. However, sinus tachycardia is still a more common electrocardiogram finding in patients with pulmonary embolism. Bullet Summary:The most common electrocardiogram finding in patients with pulmonary embolism is sinus tachycardia.
3.7
(6)
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