Slide 1: 26F presents with “panic attack.” What are the EKG findings? [EKG] What’s the dx?

Slide 2: Pulmonary embolism! [Contrast chest CT showing pulmonary embolism with filling defect (clot) in pulmonary artery]

Slide 3: Ahh, the famous S1, Q3, T3. [EKG showing S wave in lead I, Q wave in lead III, T wave inversion in lead III] First described in 1935 as a “classic” EKG finding in PE. But how common is it??

Slide 4: EKG findings in PE. Finding: frequency / likelihood ratio. | S1Q3T3: 8% / 3.7 | TWI in V1-4: 7.3% / 3.7 | TWI in V1-2: 14% / 1.8 | Tachycardia: 28% / 1.8 | Incomplete RBBB: 5% / 1.7 | Non sinus rhythm: 23% / 1.4. But about 20% of PE cases will have normal EKGs!

Slide 5: Got any cool EKGs? Email us at 12lead@coreimpodcast.com with your learning byte!

References

  • McGinn S, White PD. Acute cor pulmonale resulting from pulmonary embolism: its clinical recognition. JAMA. 1935;104(17):1473-1480.
  • Marchick MR, Courtney DM, Kabrhel C, et al. 12-lead ECG findings of pulmonary hypertension occur more frequently in emergency department patients with pulmonary embolism than in patients without pulmonary embolism. Ann Emerg Med. 2010 Apr;55(4):331-5. Epub 2009 Sep 19.
    PMID 19766353
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