pulmonary embolism ECG findings

30 Sep

Interesting article by Marchick et al from a 2010 Annals:

6,049 patients that a doc had enough suspicion for a PE to order testing (d-dimer, CTPA, V/Q scan).

Some tables worth eyeballing:

petable2

TAKEAWAYS:

sensitivity of all the ECG findings suck.  can’t rule out PE if you don’t see these.

specificity isn’t that great either (mostly in the 80s).  Among the better ones:

  • inverted anterior (V1-4) t-waves
  • S1Q3T3 (classically taught)
  • RBBB

petable3

 

TAKEAWAYS:

some context for you: compare the odds ratio of the d-dimer (a notoriously non-specific test that is elevated by many things), vs. the odds ratio of some of the more specific ECG findings.

so seeing these (e.g. anterior TWIs, S1Q3T3) may increase your suspicion for a PE, by no means is it a slam dunk.  Keep an eye out for these ECG findings, but take ’em with a grain of salt, keep your mind open.

 

References: annals article (tables from article).

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