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Electrocardiographic Differentiation between Acute Pulmonary Embolism and Non-ST Elevation Acute Coronary Syndromes at the Bedside
Article first published online: 12 APR 2010
©2010, Wiley Periodicals, Inc.
Annals of Noninvasive Electrocardiology
Volume 15, Issue 2, pages 145–150, April 2010
How to Cite
Jankowski, K., Kostrubiec, M., Ozdowska, P., Milanowska-Puncewicz, B., Pacho, S., Pedowska-Włoszek, J., Kaczyńska, A., Łabyk, A., Hrynkiewicz, A. and Pruszczyk, P. (2010), Electrocardiographic Differentiation between Acute Pulmonary Embolism and Non-ST Elevation Acute Coronary Syndromes at the Bedside. Annals of Noninvasive Electrocardiology, 15: 145–150. doi: 10.1111/j.1542-474X.2010.00355.x
- Issue published online: 12 APR 2010
- Article first published online: 12 APR 2010
- pulmonary embolism;
Background: Clinical picture of acute pulmonary embolism (APE), with wide range of electrocardiographic (ECG) abnormalities can mimic acute coronary syndromes.
Objectives: Assessment of standard 12-lead ECG usefulness in differentiation at the bedside between APE and non-ST elevation acute coronary syndrome (NSTE-ACS).
Methods: Retrospective analysis of 143 patients: 98 consecutive patients (mean age 63.4 ± 19.4 year, 45 M) with APE and 45 consecutive patients (mean age 72.8 ± 10.8 year, 44 M) with NSTE-ACS. Standard ECGs recorded on admission were compared in separated groups.
Results: Right bundle branch block (RBBB) and S1S2S3 or S1Q3T3 pattern were found in similar frequency in both groups (10 [11%] APE patients vs 6 [14%] NSTE-ACS patients, 27 [28%] patients vs 7 [16%] patients, respectively, NS). Negative T waves in leads V1-3 together with negative T waves in inferior wall leads II, III, aVF (OR 1.3 [1.14–1.68]) significantly indicated APE with a positive predictive value of 85% and specificity of 87%. However, counterclockwise axis rotation (OR 4.57 [2.74–7.61]), ventricular premature beats (OR 2.60 [1.60–4.19]), ST depression in leads V1-3 (OR 2.25 [1.43–3.56]), and negative T waves in leads V5-6 (OR 2.08 [1.31–3.29]) significantly predicted NSTE-ACS.
Conclusions: RBBB, S1S2S3, or S1Q3T3 pattern described as characteristic for APE were not helpful in the differentiation between APE and NSTE-ACS in studied group. Coexistence of negative T waves in precordial leads V1-3 and inferior wall leads may suggest APE diagnosis.
Ann Noninvasive Electrocardiol 2010;15(2):145–150