70-year old patient presenting with chest pain, dyspnoea and dizziness. BP 90/50. SaO2 83% RA. Describe the ECG



Sinus tachycardia ~ 100 bpm. Anterior T wave abnormalities: inverted in V1-3, biphasic in V4. Inferior T wave abnormalities: biphasic in III, aVF.S1Q3T3 pattern Subtle ST elevation in III and aVF. Significance of ECG Findings This pattern of T wave inversions in the right precordial leads V1-4 plus the inferior leads (especially the rightward-facing lead III) is referred to as the right ventricular strain pattern. It is a marker of right ventricular hypertrophy or dilatation. Diagnosis In a patient presenting with acute shortness of breath, the combination of Sinus tachycardia RV strain pattern in V1-4 (+/- lead III) is highly suggestive of acute cor pulmonale due to massive pulmonary embolism. However, these ECG changes are not specific to PE and may be seen in other conditions associated with pulmonary hypertension and RV enlargement including: Chronic lung disease (COPD, lung fibrosis) with chronic cor pulmonale Right ventricular hypertropy e.g. due to congenital causes, valvular heart disease Arrhythmogenic right ventricular cardiomyopathy Clinical Pearls Other ECG findings associated with pulmonary embolism include: New right axis deviation New right bundle branch block New dominant R wave in V1 Non-specific ST segment changes The oft-quoted SI QIII TIII pattern (deep S wave in lead I, Q wave in III, inverted T wave in III) is neither sensitive nor specific for PE and is infrequently seen (20% of cases). Similarly, sinus tachycardia is not as ubiquitous in PE as people seem to think (< 50% of cases), and certainly should not be relied up to exclude PE.

sinus tachycardia S1Q3T3 T wave inversion in v 1 to v4 .

pulmonary embolism. . advice. . echo CT ANGIO. . THROMBOLYSIS. ..IMMEDIATELY

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sinus tachycardia ... s wave in lead 1 ,q wave and T wave invertion in lead 3, T wave invertion in V1-V4, history examination ecg points PULMONARY EMBOLISM ... CT angiography anticoagulants ,thrombolytics,surgery ....

Very nice answer Dr. bhuvaneswari.

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MI can't alone explain hypokalemia Hypoxemia. Strain pattern in rt sided leads with classical s1 q3 t3 . Pulmonary embolism strong possibility here. Do echocardiography. Check for RA/RV dilation. Ct angio can give the diagnosis. Thrombolysis at this age requires holistic approach considering the prognosis.

Non q wave Anti Mi & inf wall ischemia low O2hypotension suggestive of LVf & adv urgent Echo for Lvef & Rwma Cardiac profile & renal profile study treatment thrombolysis Digtaliation O2 Metaprolol 12 .5 Bd cardiace 1.25 od & other supprtive treatment

T inv in V1-V4-wellan's sign -proximal LAD stenosis .Adv.CAG

inferior wall mi...right coronary artery

Anterior & inferior wall ischaemia.

anteroinferior wall infarction,

agree wth dr Narayan

Thank you sir
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