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ECG Abnormalities_Part 09

Monday, October 18, 2010

A 50 year old male with no past medical history presents to the emergency room with sudden onset severe chest pain. The pain is 10/10, substernal, sharp in nature, worse with deep inspiration, not positional or reproducible, and associated with shortness of breath and dizziness but no excessive sweating , nausea, or vomiting.

His temperature is 37.0, blood pressure 80/40, heart rate 110, respiratory rate is 28. His oxygen saturation is 88% on room air. He appears in mild distress, no jugular venous distension is present, he is tachycardic and regular without any murmurs. His lungs are clear to auscultation. The rest of his exam is normal.

His ECG is given below:

What is the Abnormality in this ECG Strip


The ECG findings include:
1) Sinus tachycardia
2) S1Q3T3 pattern consistent with acute cor pulmonale (acute right ventricular strain) a.k.a. the "McGinn-White sign"

The diagnosis is pulmonary embolism
The patient's clinic scenario of pleuritic chest pain, tachycardia, and hypoxia should raise a high clinical suspicion for pulmonary embolus. Also, his chest pain was sudden onset and severe unlike that of myocardial ischemia. Aortic disection can cause sudden-onset severe chest pain as well, however usually the patient is hypertensive and not necessarily hypoxic.


29 Responses to ECG Abnormalities_Part 09

  1. Anonymous Says:
  2. may be st depression in v2,v3

  3. Anonymous Says:
  4. SI, QIII, TIII, classic manifestation of pulmonary embolism.

  5. Anonymous Says:
  6. sinus tachycardia , s1q3t3 massive pulmonary embolism pt need thrombolytic therapy

  7. dr gan Says:
  8. s1q3t3 wit right vent strain patern n sinus tachycardia
    . wil like to test d dimer n ctpa to confirm massive embolism.

  9. Anonymous Says:
  10. st sgment elevesion lead v1,avr,t invertion v2-v4

  11. Anonymous Says:
  12. i think it must b pulmonary embolism
    but u did tell us his risk factors

  13. mkk Says:
  14. sinus tachycardia

  15. Anonymous Says:
  16. Inferior MI

  17. Karin Says:
  18. pulmonary embolism

  19. DJunes Says:
  20. Pulmonary embolism (clinical manifestation, tachycardia, s1q3t3). It's a serious case as ECG modifications are usually present in severe embolisms.

  21. Dr.GM Says:
  22. Dissecting Aorta

  23. Archana Says:
  24. sI,qIII with tachy,looks like pulmonary embolism with the clinical background.

  25. Anonymous Says:
  26. s1 q3 t3 ( pul .emboli)

  27. Anonymous Says:
  28. massive pulmonary infarction attached to the pleura

  29. Anonymous Says:
  30. pulmonary embolism......

  31. Anonymous Says:
  32. pulmonary embolism

  33. Anonymous Says:
  34. pulmonary embolism

  35. Anonymous Says:
  36. pulmonary embolism

  37. Anonymous Says:
  38. pulmonary embolism

  39. tsedhon Says:
  40. s1q3t3=massive pulmonary embolus causing rt. ventricular starin

  41. all the clinical pecture is related 2 pul.empolism(tachycardia,deficulty in breathing.chest pain that related 2 inspiration.low xygen saturation)

  42. Anonymous Says:
  43. sinus tachycardia, S1, Q3 and T3 all correlated to the scenario with the conclusion PULMONARY EMBOLISM but there is ST elevation and T wave inversion in V2, V3, isnt it representing SEPTAL MI along with PULMONARY EMBOLISM?

  44. Anonymous Says:

  46. dr jaswant Says:
  47. sinus tachycardia s1 Q3 T3 RIGHT ventricular strain wth symp[toms suggestve of acute pulmonary embolism.

  48. awais talpur Says:
  49. V1,V4 showing ST segmentation elevated its mean anterior wall MI
    lead 1 and avl also showing ST segmentation elevated may b lateral wall MI
    lead 1,avl,v1,v6 also showing st segmentation elevated it may b Extensive anterior wall MI

  50. Anonymous Says:
  51. sinus tachycardia with s1Q3T3 syndrom... acute poulmonary embolism

  52. Anonymous Says:
  53. Dissecting Aorta,

  54. Anonymous Says:
  55. S1 q3 t3 with rv strain.

  56. Anonymous Says:
  57. Emnolia pulmonum S1Q3T3


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