Document Detail

12-lead ECG findings of pulmonary hypertension occur more frequently in emergency department patients with pulmonary embolism than in patients without pulmonary embolism.
MedLine Citation:
PMID:  19766353     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: Acute pulmonary embolism can produce abnormalities on ECG that reflect severity of pulmonary hypertension. Early recognition of these findings may alter the estimated pretest probability of pulmonary embolism and prompt more aggressive treatment before hemodynamic instability ensues, but it is first important to test whether these findings are specific to patients with pulmonary embolism. We hypothesize that ECG findings consistent with pulmonary hypertension would be observed more frequently in patients with pulmonary embolism. METHODS: Secondary analysis of a prospective, observational cohort of emergency department patients who were tested for pulmonary embolism. ECGs were ordered at clinician's discretion and interpreted at presentation. RESULTS: Six thousand forty-nine patients had an ECG, 354 (5.9%) of whom were diagnosed with pulmonary embolism. The frequency, positive likelihood ratio (LR+) and 95% confidence interval (CI) of each predictor were as follows: S1Q3T3 8.5% with pulmonary embolism versus 3.3% without pulmonary embolism (LR+ 3.7; 95% CI 2.5 to 5.4); nonsinus rhythm, 23.5% versus 16.6% (LR+ 1.4; 95% CI 1.2 to 1.7); inverted T waves in V1 to V2, 14.4% versus 8.1% (LR+ 1.8; 95% CI 1.3 to 2.3); inversion in V1 to V3, 10.5% versus 4.0% (LR+ 2.6; 95% CI 1.9 to 3.6); inversion in V1 to V4, 7.3% versus 2.0% (LR+ 3.7; 95% CI 2.4 to 5.5); incomplete right bundle branch block, 4.8% versus 2.8% (LR+ 1.7; 95% CI 1.0 to 2.7); tachycardia (pulse rate >100 beats/min), 28.8% versus 15.7% (LR+ 1.8; 95% CI 1.5 to 2.2). Likelihood ratios and specificities were similar when patients with previous cardiopulmonary disease were excluded from analysis. CONCLUSION: Findings of acute pulmonary hypertension were infrequent overall but were observed more frequently in patients with the final diagnosis of pulmonary embolism compared with patients who do not have pulmonary embolism.
Michael R Marchick; D Mark Courtney; Christopher Kabrhel; Kristen E Nordenholz; Michael C Plewa; Peter B Richman; Howard A Smithline; Jeffrey A Kline
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2009-09-19
Journal Detail:
Title:  Annals of emergency medicine     Volume:  55     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-29     Completed Date:  2010-04-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  331-5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28323-2861, USA.
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MeSH Terms
Bundle-Branch Block / diagnosis,  physiopathology
Confidence Intervals
Electrocardiogram Pattern
Emergency Service, Hospital*
Hypertension, Pulmonary / diagnosis,  etiology*,  physiopathology
Likelihood Functions
Logistic Models
Middle Aged
Prospective Studies
Pulmonary Embolism / complications*,  diagnosis,  physiopathology
Tachycardia / diagnosis,  physiopathology
Grant Support

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