BAS 9/16/02

EKG in Pulmonary Embolism

Key Points:
• The EKG is often abnormal in PE, but the findings are insensitive and non-specific.
• The most common findings are sinus tachycardia and/or non-specific ST-T changes.
• Anterior (V1-V4) T-wave inversions have reasonable sensitivity and specificity for massive PE.

Ferrari et al. The ECG in pulmonary embolism. Chest 1997;111:537-543

• 80 consecutive hospitalized CCU patients with acute PE, all underwent pulmonary angiography
• Excluded 12 pts with “a history of cardiopulmonary disease that could have modified the ECG”
Finding Percentage of patients with EKG finding
T waves neg V1-V4 68%
S1 Q3 T3 pattern 50%
Peripheral low voltage 29%
Sinus tachycardia 26%
Complete/incomplete RBBB 22%
Pulmonary P wave 5%
Normal 9%
• In massive PE (determined angiographically), anterior ischemic pattern was noted in 85% of
patients versus 19% in nonmassive PE; no other parameter correlated with severity
• Anterior T-wave inversions has a sensitivity of 85%, specificity of 81%, PPV of 93%, and a
NPV of 65% for massive PE in patients w/ suspected PE.

Rodger et al. Diagnostic value of the elctrocardiogram in suspected pulmonary embolism. Am J

Cardiol 2000;86:807-809.

• 246 consecutive inpatients and outpatients referred for V/Q scan or pulmonary angiogram.
Diagnosis made by usual PIOPEDesque means. “No PE” meant <5% post-test prob, “PE” meant >
88% post-test prob. 20% had PE, 66% had no PE, and 14% excluded because of no definite
diagnosis.
BAS 9/16/02

Stein, PD, et al. Clinical characteristics of patients with acute pulmonary embolism. Am J Cardiol.
1991;68:1723.
• A retrospective study of 117 patients with acute PE, non-specific ST-T changes were the most
common finding on EKG (49%)

Nielsen TT, et al. Changing electrocardiographic findings in pulmonary embolism in relation to

vascular obstruction. Cardiology 1989;6:274.
• A study of 87 patients with minor to massive P, 82% had changes suggestive of acute right
ventricular strain (RBBB, S1Q3T3, inverted precordial T waves, or R axis shift)

One review:
Falterman TJ, Pulmonary embolism with St segment elevation in leads V1 to V4: case report and
review of the literature regarding electrocardiographic changes in acute pulmonary embolism. J
Emerg Med. 2001;3:255.

Initial report of our beloved S1Q3T3: McGinn S, White PD. Acute cor pulmonale resulting from pulmonary
embolus. JAMA 1935;104:1463-1480.