ECG in suspected pulmonary embolism

Thomson, D., Kourounis, G., Trenear, R., Messow, C.-M. , Hrobar, P., Mackay, A. and Isles, C. (2019) ECG in suspected pulmonary embolism. Postgraduate Medical Journal, 95(1119), pp. 12-17. (doi: 10.1136/postgradmedj-2018-136178) (PMID:30665906)

Abstract

Objective: To establish the diagnostic value of prespecified ECG changes in suspected pulmonary embolism (PE). Methods: Retrospective case–control study in a district general hospital setting. We identified 189 consecutive patients with suspected PE whose CT pulmonary angiogram (CTPA) was positive for a first PE and for whom an ECG taken at the time of presentation was available. We matched these for age±3 years with 189 controls with suspected PE whose CTPA was negative. We considered those with large (n=76) and small (n=113) clot load separately. We scored each ECG for the presence or absence of eight features that have been reported to occur more commonly in PE. Results: 20%–25% of patients with PE, including those with large clot load, had normal ECGs. The most common ECG abnormality in patients with PE was sinus tachycardia (28%). S1Q3T3 (3.7%), P pulmonale (0.5%) and right axis deviation (4.2%) were infrequent findings. Right bundle branch block (9.0%), atrial dysrhythmias (10.1%) and clockwise rotation (20.1%) occurred more frequently but were also common in controls. Right ventricular (RV) strain pattern was significantly more commonly in patients than controls, 11.1% vs 2.6% (sensitivity 11.1%, specificity 97.4%; OR 4.58, 95% CI 1.63 to 15.91; p=0.002), particularly in those with large clot load, 17.1% vs 2.6% (sensitivity 17.1%, specificity 97.4%; OR 7.55, 95% CI 1.62 to 71.58; p=0.005). Conclusion: An ECG showing RV strain in a breathless patient is highly suggestive of PE. Many of the other ECG changes that have been described in PE occur too infrequently to be of predictive value.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Messow, Dr Martina and Isles, Dr Christopher and Kourounis, Dr Georgios
• Authors: Thomson, D., Kourounis, G., Trenear, R., Messow, C.-M., Hrobar, P., Mackay, A., and Isles, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Postgraduate Medical Journal
• Publisher: BMJ Publishing Group
• ISSN: 0032-5473
• ISSN (Online): 1469-0756
• Published Online: 21 January 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Postgraduate Medical Journal 95(1119): 12-17
• Publisher Policy: Reproduced in accordance with the publisher copyright policy