Review Question - QID 104008

This patient with sudden-onset shortness of breath and signs of deep vein thrombosis in the lower extremity after a recent surgery likely has a pulmonary embolism. The most common electrocardiogram finding in patients with pulmonary embolism is sinus tachycardia.

Patients who are sedentary after surgery are at an increased risk of developing deep vein thrombosis (DVT), most commonly in the lower extremity. This risk is particularly elevated for patients undergoing orthopedic surgeries such as total hip arthroplasty as in this patient. DVTs in the lower extremity may then travel to the lung via the venous circulation and result in pulmonary embolism. Presenting signs and symptoms include tachycardia, shortness of breath, and jugular venous distention. Sinus tachycardia is the most common electrocardiogram finding in pulmonary embolism. Other electrocardiogram findings include right bundle branch block or T wave inversions in leads V1-V3. The test of choice to diagnose patients with suspected pulmonary embolism is CT angiography of the chest. Patients are typically treated with blood thinners.

Ramzi and Leeper summarize the diagnosis of PE. Research has indicated that helical CT scanning can detect large PEs with a sensitivity and specificity of nearly 90% for main and lobar emboli.

Incorrect Answers:
Answer 1: Left ventricular hypertrophy may be observed on electrocardiogram. However, it typically develops over years secondary to hypertension or aortic stenosis. It is not associated with pulmonary embolism.

Answer 2: New onset left bundle branch block may sometimes be observed in patients with myocardial infarction, particularly those affecting the left anterior descending artery. It is not associated with pulmonary embolism.

Answer 3: ST segment elevations in all leads with diffusely low amplitude is suggestive of pericarditis. Pericarditis might present with chest pain worsened by leaning back and relieved by leaning forward.

Answer 4: ST segment elevations in leads II, III, and aVF would suggest an inferior myocardial infarction, which may present similarly to pulmonary embolism. This patient's recent surgical history and signs of DVT make pulmonary embolism more likely.

Bullet Summary:
In patients with pulmonary embolism, the most common finding on electrocardiogram is sinus tachycardia.