Inverted T waves on electrocardiogram: myocardial ischemia versus pulmonary embolism

Sarin, Sanjay; Elmi, Farhad; Nassef, Louis A.

doi:10.1016/j.jelectrocard.2005.05.008

Cited by 13 publications

(9 citation statements)

References 13 publications

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“…It may be associated with the development of acute cor pulmonale, which features rapid right ventricular pressure overload and enlargement [1,2,5]. Some studies have attributed the mechanism of NTW to myocardial ischemia, and the release of various chemical mediators such as catecholamines and histamine [10-13]. …”

Section: Discussionmentioning

confidence: 99%

Normalization of Negative T-Wave on Electrocardiography and Right Ventricular Dysfunction in Patients with an Acute Pulmonary Embolism

Choi

Park

2012

Korean J Intern Med

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Background/AimsRight ventricular dysfunction (RVD) is associated with poor prognosis in patients with acute pulmonary embolism (APE). Echocardiography and computed tomography (CT)-angiography may be difficult to perform in a serial follow up, unlike electrocardiography (ECG). Many ECG findings specific for APE have been reported, and many studies have found that negative T-waves (NTW) in precordial leads are most frequently observed in patients with APE. We analyzed serial changes in precordial NTW to detect RVD and predict the recovery of RVD in patients with APE.MethodsWe examined 81 consecutive patients diagnosed with APE using CT-angiography or echocardiography. ECG, transthoracic echocardiography, and laboratory tests were performed within 24 hours of admission, and daily ECG follow-up was performed. Precordial NTWs were defined by the new development of pointed and symmetrical inverted T-waves in at least three leads. Recovery of NTW was defined as flattening or upright inverted T-waves in more than two leads.ResultsOf the 81 patients with APE, 52 (64%) had RVD according to echocardiography. Among the patients with RVD, 33 (63%) showed precordial NTW. The multivariate logistic regression analysis revealed that NTW was the strongest independent predictor for RVD (odds ratio, 22.8; 95% confidence interval, 2.4 to 221.4; p = 0.007). Time to normalization of NTW was associated with improvement of RVD on echocardiography (r = 0.84, p < 0.01).ConclusionsPrecordial NTW was a reliable finding to identify RVD in patients with APE. Improvements in RVD can be predicted by normalizing precordial NTW.

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Section: Discussionmentioning

confidence: 99%

Normalization of Negative T-Wave on Electrocardiography and Right Ventricular Dysfunction in Patients with an Acute Pulmonary Embolism

Choi

Park

2012

Korean J Intern Med

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“…In this report, we describe an unusual case of a 38-year-old woman who had pulmonary embolism (PE) and reverse takotsubo cardiomyopathy. PE has been listed as stressors of stress-induced cardiomyopathy,2)3) because the pain and the decreased perfusion within the lung related to PE probably cause a release of catecholamines 4)5). However, it is uncommon to present reverse types of stress-induced cardiomyopathy in the setting of PE for our patient.…”

Section: Introductionmentioning

confidence: 80%

“…The exact mechanisms of the relation between PE and atypical takotsubo cardiomyopathy are not clear. But increased catecholamine levels during severe pain and perfusion defect within the lung related to PE seem to result in the development of LV wall motion abnormalities 4)5). In this case, it is difficult to detect PE and reverse takotsubo cardiomyopathy independently, due to the fact that both clinical features mimic acute coronary syndromes.…”

Section: Discussionmentioning

confidence: 99%

“…Despite of the poor sensitivity and specificity of ECG abnormalities to diagnose PE and inverse takotsubo cardiomyopathy, there are several frequent features including sinus tachycardia, both complete and incomplete RBBB, S 1 Q 3 T 3 pattern, and ST-segment elevation, non specific T wave abnormalities, respectively 2)4-6). A transthoracic echocardiography (TTE) provide the evidence of PE such as right ventricular systolic dysfunctions and pulmonary hypertensions,4)5) and stress-induced cardiomyopathy may have right ventricular involvement which is associated with more severe impairments in LV systolic functions 14). Thus, it is important to carry out ECG promptly, TTE and coronary angiography based on a high degree of clinical suspicions.…”

Section: Discussionmentioning

confidence: 99%

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Inverted-Takotsubo Cardiomyopathy in a Patient with Pulmonary Embolism

et al. 2013

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As the use of early coronary angiography and echocardiography become widely available in the setting of acute coronary syndrome, the gradual increase for variant forms of transient left ventricular (LV) apical ballooning syndrome have been recognized. This syndrome usually occurs in women and is frequently elicited by an intense emotional, psychological, and physical event. While the patients' characteristics between typical and non-typical LV ballooning syndrome seem to differ, the presentation, clinical features, and reversibility of LV wall motion abnormalities are similar. We present a middle-aged woman who experienced inverted takotsubo cardiomyopathy triggered by pulmonary embolism. To the best of our knowledge, this case is particularly unique and is rarely reported in the disease entity.

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“…Findings such as the S1Q3T3 pattern lack sensitivity and specificity, and also show no correlation with the severity of PE [2,3]. Several studies have stated that T-wave inversion in lead III, aVF and precordial leads is most often associated with massive PE and/or PE with RV dysfunction, ascribing a high sensitivity, specificity, positive and negative predictive value to these findings [3][4][5][6]. Negative T waves in both leads III and V 1 have been reported to accurately differentiate acute PE from acute coronary syndrome [4].…”

Section: Discussionmentioning

confidence: 99%

Acute Pulmonary Embolism Masquerading as Acute Inferior Myocardial Infarction

Obiagwu

2014

J Med Cases

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It is always important to maintain a high index of suspicion in the diagnosis of acute pulmonary embolism (PE). Death in patients with undiagnosed PE was shown to be 4 -6 times higher than in those with a definite diagnosis and treatment. The ECG as much as it has great utility, unfortunately lacks sensitivity and specificity, providing findings that might serve as red herrings to the unsuspecting physician by suggesting an alternative diagnosis. This report describes a woman whose EKG showed ST segment elevations suggestive of acute inferior wall myocardial infarction (MI), but eventually was found to have a sub-massive PE.

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Inverted T waves on electrocardiogram: myocardial ischemia versus pulmonary embolism

Cited by 13 publications

References 13 publications

Normalization of Negative T-Wave on Electrocardiography and Right Ventricular Dysfunction in Patients with an Acute Pulmonary Embolism

Normalization of Negative T-Wave on Electrocardiography and Right Ventricular Dysfunction in Patients with an Acute Pulmonary Embolism

Inverted-Takotsubo Cardiomyopathy in a Patient with Pulmonary Embolism

Acute Pulmonary Embolism Masquerading as Acute Inferior Myocardial Infarction

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