Download Clinical update no. 288 20 September 2012

Clinical update no. 288 20 September 2012

An ECG finding of simultaneous T-wave inversions in the anterior and inferior leads may be found in pulmonary embolus, and should be distinguished from changes in acute coronary syndrome. Among several other ECG

63yr-M with syncopal episode followed by

abnormalities tested, only sinus tachycardia

chest pain and diaphoresis. No cardiac history,

and the S1-Q3-T3 pattern distinguished PE

previously well. Hypotensive with CDA, BP

from ACS. Simultaneous T-wave inversions in

110/70 in ED, HR 80 bpm. Progress ECG

anterior and inferior leads are associated with PE and are seen in 4–11%.

There had been some resolution of ST depression, seen previously in V3-V5. Serial

Previous studies have also shown that

troponin 80. Admitted under cardiology as

patients with PE frequently had simultaneous

NSTEMI. Coronary angiogram showed minor disease only in LAD. Subsequently had CT-PA showing extensive bilateral PE

T-wave inversions in anterior/inferior leads, especially lead III. In contrast, only 1% of patients with ACS had simultaneous T-wave inversions in anterior/inferior leads. The current study confirms that this finding is more prevalent in PE than in ACS. Although it is an infrequent finding in PE with a sensitivity of 6 mm in V1, right axis deviation, and right atrial changes (P wave >2.5mm in II and > 1.5 mm in V1)

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