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."