Right ventricular hypertrophy due to pulmonary embolism [150 ECG] - Bài viết - Bệnh Học
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Right ventricular hypertrophy due to pulmonary embolism [150 ECG]

Cho điểm
Right ventricular hypertrophy due to pulmonary embolism
A 32-year-old woman, who had had a normal pregnancy and delivery 3 months previously, was seen in the
outpatient department complaining of severe breathlessness and dizziness on exertion. She had some chest pain on both sides, which sounded pleuritic. Does her ECG help with her diagnosis and treatment? A pulmonary ngiogram was performed as part of a series of investigations.


ANSWER 96
The ECG shows:
• Sinus rhythm, rate 79/min
• Right axis deviation
• Normal QRS complexes, except for an RSR1 pattern in lead V1 and deep S waves in lead V6
• Inverted T waves in leads V1–V4
The pulmonary angiogram shows clots within the main pulmonary arteries. The right mid-zone is perfused, but the rest of the lung fields have poor or no perfusion due to multiple pulmonary emboli.
Clinical interpretation
The right axis deviation, the deep S waves in lead V6 (‘clockwise rotation’) and the inverted T waves in the chest leads are all characteristic of marked right ventricular hypertrophy: the only missing feature is the absence of dominant R waves in lead V1. Note how the T wave inversion is at a maximum in lead V1 and becomes progressively less marked from lead V2 to V4.
What to do
In the context of a delivery 3 months previously, this ECG pattern of right ventricular hypertrophy almost certainly indicates multiple pulmonary emboli causing pulmonary hypertension. The pulmonary angiogram confirms this diagnosis. Anticoagulants, and possibly thrombolysis, are needed urgently.
Summary
Rightventricularhypertrophyduetopulmonaryembolism.
Nguồn: 150 ECG Problems (4th Edition)
Tác giả: John R. Hampton

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