ELECTROCARDIOGRAM, PULMONARY PRESSURE AND ANGIOGRAPHIC INDEX - INTERRELATIONSHIPS, CLINICAL AND DIAGNOSTIC VALUE IN PULMONARY EMBOLISM
Authors: Rodica Avram
Despite advances in modern medicine, pulmonary embolism remains a disease with high mortality and cause of preventable death, majority attributed to missed diagnosis; the nonspecific signs and symptoms require a complex paraclinical diagnostic algorithm.
Electrocardiogram was the first investigation communicated by McGinn and White (1935) and further diagnostic criteria as specific as possible were researched. In patients with severe pulmonary embolism, the electrocardiogram is normal in 6% compared to 23% in moderate forms. Fibrillation and atrial flutter are present in severe and moderate pulmonary embolism. As isolated or associated ECG abnormality - right axial deviation, right bundle branch block, right atrium abnormalities, S1Q3T3 is seen in 30% of severe forms, less frequently than ST and T abnormalities.
We selected a number of 38 patients from our casuistry without cardiovascular or respiratory disease, recorded clinical data, ECG, pulmonary pressure in relation to CT angiographic index. We followed the clinical data, ECG and echocardiography in these patients.
Electrocardiogram was normal in 6 patients with pulmonary artery pressure below 40mmHg. Significant increase in pulmonary pressure and angiographic index above 10 was accompanied by ST-T abnormalities in 16 patients, complete right bundle branch block and incomplete in 9, right atrium abnormalities 6p, S1Q3T3 in 6 patients, right axis deviation in 6; right bundle branch block and S1Q3T3 occurred in 8 patients with severe clinical forms, with impaired right ventricular function, higher angiographic index.
In evolution, ECG abnormalities were improved in 12 p, in an interval of 7-14 days, in 10 p. in 10-45 days, after reducing pulmonary pressure and also after the improvement of right ventricular function.
- Although non-specific, electrocardiogram may be a first paraclinical element for suspected pulmonary embolism
- The association of electrocardiographic abnormalities with elevated pulmonary pressure, as well as their parallel remission, suggest that ventricular dysfunction, represents the major cause of electrocardiographic changes.