Electrocardiographic changes in pulmonary embolism with special reference to an early and transient shift of the electrical axis of the heart

Kuo, Ping-Hung; Veer, Joseph B. Vander

doi:10.1016/0002-8703(50)90180-3

Cited by 18 publications

(7 citation statements)

References 23 publications

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“…Simple clinical procedures such as history, physical ex amination and chest x-ray may help the physician to suspect this condition [25,26], ECG has been used with little success to diagnose pulmonary embolism [4,5,7,9]. Patterns as SiQyTy or RBBB, previously described as typical for pulmonary embo lism, do not occur frequently [6].…”

Section: Discussionmentioning

confidence: 99%

Routine Electrocardiography in Screening for Pulmonary Embolism

et al. 1986

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In a group of 245 patients with clinical suspicion of pulmonary embolism we analyzed the ECG for 22 signs that have been associated with this disease. Subsequently, the patients were divided into two groups: those with confirmed embolism and those in whom embolism was not confirmed. The occurrence of the ECG signs was assessed separately for the two groups. Furthermore, we related ECG features to severity of embolism as estimated at lung scan. Tachycardia and S-T depression were the commonest findings in both groups. P-R displacement, late R in aVR, S₁Q₃T₃, S slurred and T inversion in V₁-V₂ were more frequent in embolic than in nonembolic patients (p < 0.05 or less). All the abovementioned signs were more frequent at diagnosis than at recovery in embolic patients (p < 0.05 or less), whereas only tachycardia was more frequent at diagnosis than at control in nonembolic patients (p < 0.001). S-T depression and T inversion in V₁-V₂ were also associated to severity of embolism.Since some ECG signs are very frequent or specific in pulmonary embolism, this condition should always be suspected when they are found and, particularly, when previously absent in the same patients and/or not explained by other conditions

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Section: Discussionmentioning

confidence: 99%

Routine Electrocardiography in Screening for Pulmonary Embolism

et al. 1986

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“…Wood (1948) found it occasionally in massive pulmonary embolism and Zuckerman et al (1950) mention right auricular dilatation as a late finding in experimental animals but they had no example in their clinical cases. Laham and Gerbaux (1951) found no P wave 51 CUTFORTH AND ORAM abnormalities in 57 cases of pulmonary embolism. However, Eliaser and Giansiracusa (1952) found " P pulmonale " as a late manifestation in three out of eight cases.…”

Section: Durationmentioning

confidence: 88%

“…Depression of the S-T segment in leads I and II was mentioned as a significant finding in the original paper of McGinn and White (1935). Other authors, among them Murnaghan et al (1943), Zuckerman et al (1950), andLaham andGerbaux (1951) have since pointed out that the S-T segment depression can also appear in lead VL and in those precordial leads which face the left ventricle. Elevation of the S-T segment sometimes occurs in lead VR and, to a slight extent, in those prxcordial leads that face the right ventricle.…”

Section: Durationmentioning

confidence: 96%

“…He found that sharp inversion of the T wave occurred without appreciable displacement of the S-T segment. It has since been clearly established by Wood (1948), Myers et al (1948), Phillips and Levine (1950), Laham and Gerbaux (1951), White (1951), Eliaser andGiansiracusa (1952), andNewman (1952) that in pulmonary embolism the T wave may be inverted in those prxcordial leads that face the right ventricle.…”

Section: Durationmentioning

confidence: 96%

“…McGinn and White (1935) noted that none of their cases showed left axis deviation. Kuo and Vander Veer (1950) pointed out that alteration in the electrical axis may be an early and transient phenomenon. Phillips and Levine (1950) mention the importance of clockwise rotation and its value in differential diagnosis, and this point is also stressed by Goldberger (1953).…”

Section: Analysis Of the Electrocardiographic Findings In This Seriesmentioning

confidence: 99%

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The Electrocardiogram in Pulmonary Embolism

Cutforth¹,

Oram²

1958

Heart

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The importance of the electrocardiogram in the diagnosis of pulmonary embolism was first demonstrated by McGinn and White (1935) but general opinion still varies concerning the precise diagnostic value of this method of investigation. As recently as 1952 Newman stated that in only 10-20 per cent of cases of pulmonary embolism is there a characteristic pattern and that electro--cardiographic examination is not a good method of making the diagnosis. By contrast, Phillips and Levine (1950) are of the opinion that the diagnosis of pulmonary embolism can be made with a high degree of accuracy and, indeed, that the first clue to the diagnosis may often be found by this method.The object of this paper is to analyse in detail the electrocardiograms of 50 undoubted cases of pulmonary embolism and to compare these results with those of other workers in order to assess its value in making the diagnosis. In addition, an attempt is made to correlate the severity of the clinical picture with the electrocardiogram, and also to show how the presence or absence of pulmonary infarction affects it. MATERIAL AND METHOD OF SELECTIONThe material was obtained from the records of four hospitals. About a quarter of the cases were seen personally by one of us within 24 hours of the time at which the embolism occurred. All patients had at least one 12-lead electrocardiogram (the three standard leads, the three unipolar limb leads, and six chest leads, VI-6) taken after the embolism and in 25 instances serial records were obtained.In a study of this kind there are two practical difficulties in obtaining suitable material. The first is to obtain records from patients in whom there is no doubt whatsoever concerning the certainty of the diagnosis. This is discussed below and our diagnostic criteria are given. The second difficulty is that those patients who die very soon after the onset of the embolism frequently do so before there is time for an electrocardiogram to be taken. In this series of 50 patients there are 11 in whom the diagnosis was verified after death. The post-mortem examinations revealed that the coronary arteries were patent in all except Case 43, and this case is discussed separately.Details of the 11 cases that came to autopsy can be seen in Table I.In addition to the autopsied cases we studied 83 other patients in whom a clinical diagnosis of pulmonary embolism had been made but we discarded 44 of these because, in our opinion, the clinical picture was not certain enough to put the diagnosis beyond all doubt. The remaining 39 patients were considered by us to be undoubted examples of pulmonary embolism, our criteria being as follows.Twenty-one suffered a sudden attack of pleuritic pain followed in a few days by hrmoptysis. This attack occurred either within 14 days of a surgical operation or in the presence of a recent venous thrombosis. In none of them did we find any cause other than pulmonary embolism that could explain the clinical picture. In addition, every patient in this group had either 41 on 12 May 2018 by guest....

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Pulmonary Embolism

Krause¹,

Silverblatt²

1955

AMA Arch Intern Med

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Pulmonary embolism is a not uncommon complication in patients hospitalized for other medical and surgical diseases. The autopsy incidence of pulmonary embolism is much higher than that anticipated by clinical diagnosis.* For these reasons we have reviewed the cases of pulmonary embolism that have occurred at Montefiore Hospital during the past five years. Certain clinical features, not sufficiently emphasized in the medical literature, were discovered to occur in a high incidence. The electrocardiogram, a good collateral aid in the diagnosis of pulmonary embolism, is usually not obtained early enough, often enough, nor in a serial fashion.Sixty-seven records were examined, and of this group 62 cases were selected, because in 5 instances the available data were inadequate for proper analysis. Of the 62 cases, 33 were autopsied and in 29 the patients recovered. Forty-nine were medical cases, and 13 were surgical. The complicating medical features in the patients selected were as follows : congestive heart failure, 37; myocardial infarct, 8; pneumonia, 2 ; cerebral vascular accident, 1 ; throm¬ bophlebitis, 1. Pulmonary embolus complicated the following surgical procedures : herniorrhaphy, 4 ; :olonic resection of carcinoma, 4 ; cholecystectomy, -; suprapubic cystotomy, 1 ; orchiectomy, 1 ; cata-"act, 1. Of the 33 autopsied cases of pulmonary :mboIism, 25 medical and 8 surgical, only 9 were orrectly diagnosed before death. Forty-one patients lad electrocardiograms, and 36 had chest x-rays.The pathology of pulmonary embolism can be classified under two chief categories.These are (1) massive, fatal pulmonary em¬ bolism without pulmonary infarction and (2) pulmonary embolism with pulmonary infarc¬ tion. In those instances of massive, fatal pulmonary embolism without pulmonary in¬ farction, the main stem of the pulmonary artery and the larger branches are blocked by a clot that is twisted, cylindrical or thick¬ ened, fragmented or intact, varying in length from 15 to 30 cm. Statistically, the cylindri¬ cal clots take origin in the femoral and ex¬ ternal iliac veins. The thicker masses with a large number of tree-like branches usually arise in the bed of the internal iliac vein, originating most frequently in the uterine veins. The embolus may show valve mark¬ ings and small broken branches which can be matched with the valves and tributary veins of the leg vessel of origin. Because death is usually sudden, there is inadequate time for pulmonary infarction and secondary pathological changes to appear. The lungs are only slightly edematous and hyperemic. The right ventricle is usually dilated. In¬ farction of the lung secondary to pulmonary embolism occurs in a high incidence. In our series of 33 autopsied cases this lesion re¬ sulted in 24 instances. Usually the infarct is pyramidal or wedge-shaped, with its base directed pleurally and its apex at the site of vascular occlusion. The very fresh infarc¬ tions, however, are not so sharply defined, but merge with the surrounding pulmonary parenchyma through a zone of edema a...

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Electrocardiographic changes in pulmonary embolism with special reference to an early and transient shift of the electrical axis of the heart

Cited by 18 publications

References 23 publications

Routine Electrocardiography in Screening for Pulmonary Embolism

Routine Electrocardiography in Screening for Pulmonary Embolism

The Electrocardiogram in Pulmonary Embolism

Pulmonary Embolism

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