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Large PE’s can often mimic STEMI with ST-segment elevation (especially in rightward leads). STEMI’s don’t tend to produce a rightward axis. Rightward axis in apparent “STEMI”? Pay attention to the axis and consider large PE!
ECG findings in PE
Sinus tachycardia
Atrial/ventricular dysrhythmias
Signs of right heart strain
Tall R wave in V1
Rightward axis
TWIs (esp. anteroseptal +/- inferior leads)
ST changes, including STE in rightward leads (V1, V2, aVR, III)
ECG findings in PE associated with hemodynamic instability and increased morbidity and mortality
Note that these are not necessarily specific for PE
TWIs in right precordial leads
ST-segment elevation and depression
Especially STE in aVR, V1-V2, III
Tachycardia (sinus, afib/flutter)
Signs of right heart strain (rightward axis, tall R wave in V1)
References:
Shopp JD, Stewart LK, Emmett TW, Kline JA. Findings From 12-lead Electrocardiography That Predict Circulatory Shock from Pulmonary Embolism: Systematic Review and Meta-analysis. Acad Emerg Med 2015;22(10):1127–37. PMID:26394330
Dibgy,GC, Kulka P, Zhan ZQ, et al. The value of electrocardiographic abnormalities in the prognosis of pulmonary embolism: a consensus paper. Ann Noninvasive Electrocardiol 2015. May;20(3):207-23. PMID:25994548
Kukla P, McIntyre WF, Fijorek K, et al. Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock. Am J Emerg Med 2014;32(6):507–10. PMID:24602894
Zhan Z-Q, Wang C-Q, Nikus KC, et al. Electrocardiogram patterns during hemodynamic instability in patients with acute pulmonary embolism. Ann Noninvasive Electrocardiol 2014;19(6):543–51.PMID:24750207
Abarca E, Baddi A, Manrique R. ECG manifestations in submassive and massive pulmonary embolism. Report of 4 cases and review of literature. Journal of Electrocardiology 2014;47(1):75–9. PMID:23890684
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