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    
Abstract/OtherAbstract:
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.
Authors:
Michael R Marchick; D Mark Courtney; Christopher Kabrhel; Kristen E Nordenholz; Michael C Plewa; Peter B Richman; Howard A Smithline; Jeffrey A Kline
Related Documents :
12685053 - Diagnosis of pulmonary embolism: when is imaging needed?
23019173 - Intra-aneurysmal pressure and flow changes induced by flow diverters: relation to aneur...
22825863 - Endovascular treatment for the spontaneous rupture of a non-aneurysmal subdiaphragmatic...
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.
Affiliation:
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28323-2861, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Bundle-Branch Block / diagnosis,  physiopathology
Confidence Intervals
Electrocardiogram Pattern
Electrocardiography*
Emergency Service, Hospital*
Female
Humans
Hypertension, Pulmonary / diagnosis,  etiology*,  physiopathology
Likelihood Functions
Logistic Models
Male
Middle Aged
Prospective Studies
Pulmonary Embolism / complications*,  diagnosis,  physiopathology
Tachycardia / diagnosis,  physiopathology
Grant Support
ID/Acronym/Agency:
K23HL077404/HL/NHLBI NIH HHS; R01 HL074384/HL/NHLBI NIH HHS; R41HL074415/HL/NHLBI NIH HHS; R42HL074415/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Acute Detection of ST-Elevation Myocardial Infarction Missed on Standard 12-Lead ECG With a Novel 80...
Next Document:  Levosimendan as a Rescue Drug in Experimental Propranolol-Induced Myocardial Depression: A Randomize...