Saturday, April 2, 2011

Is it pulmonary embolism?

This is a 41 year old male with severe asthma who barely avoided intubation.  His troponin returned at 0.13, and here is his ECG:

There is sinus tach with anterior T-wave inversion of the same morphology as the previous cases of PE which I have posted (see link below).  There is no TW inversion in lead III, so this is not pathognomonic.  Whether or not there is T-wave invesion, this ECG could be due to PE or any cause of right heart strain.


Here are some cases of pulmonary embolism.


This is to illustrate that these T-wave inversions are due to acute right heart strain, which is caused by many etiologies other than PE, including but not limited to acute severe asthma and acute pneumonia.  Hypoxia causes pulmonary vasoconstriction (pulmonary hypoxic vasocontriction) which puts strain on the right heart.

Pulmonary embolism was ruled out.
Posted by Steve Smith at 12:31 PM
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4 comments:

  2. It could be Wellens', but it has a different look than Wellens' because of the humped look of the T-wave. All I can do is refer you to a couple Wellens' cases, and contrast with PE cases further down

    Wellens: http://hqmeded-ecg.blogspot.com/2011/05/wellens-missed-then-returns-with.html

    Wellens: http://hqmeded-ecg.blogspot.com/2011/03/classic-evolution-of-wellens-t-waves.html

    Another pulm embolism: http://hqmeded-ecg.blogspot.com/2011/03/chest-pain-sob-anterior-t-wave.html

    Another pulm embolism: http://hqmeded-ecg.blogspot.com/2010/03/anterior-t-wave-inversion-due-to.html

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  3. so if there are twi in lead iii then it cant be pneumonia/asthma?

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    Replies

    1. No. One cannot tell the difference on the ECG among these etiologies of acute right heart strain. Even TWI in lead III won't help you.

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