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sábado, 30 de julio de 2016

EKG patterns of PE which mimic MI

Pulm CRIT (EM CRIT)
Pulm CRIT (EM CRIT) - July 30, 2014 by Josh Farkas
"RV strain pattern
  • T-wave inversion in V1 and V2
    • At least one of the following:
      • T-wave inversion in lead III
      • The precordial lead with deepest T-wave inversion is V1 or V2
  • RV injury pattern
    • ST elevation in aVR and ST depression in lead I
    • ST elevation in V1-V3 and/or ST depression in V4-V6
Conclusions
  • Acute PE often mimics MI by causing two patterns, which may occur together or separately. Both patterns are usually associated with submassive or massive PE, requiring immediate recognition and treatment.
  • RV injury pattern must be included in the differential diagnosis of ST elevation in aVR.
  • RV injury pattern is not specific for PE. In the presence of this pattern, a terminal S-wave in lead I and a terminal R-wave in lead III may point towards PE.
  • When there is uncertainty regarding whether the patient has PE or MI, there should be a low threshold to obtain immediate bedside echocardiography."