Pulmonary Embolism

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Tachycardia, S1Q3T3, tall P wave in II, ST elevation in right-sided leads (aVR, V1, III), right axis deviation, new right bundle branch block, new incomplete right bundle branch block, and T wave inversions especially in the inferior and right-sided precordial leads (II, III, aVF, V1, V2, and V3) have all been suggested as right heart strain patterns.

Examples

ECG Showing Pulmonary Embolism

Pulmonary Embolism

Anterior precordial and inferior T-wave inversions are common findings of acute right heart strain. This patient had a submassive pulmonary embolism.
ECG Showing Pulmonary Embolism

Pulmonary Embolism

This patient was discovered to have a pulmonary embolism with right heart strain. The ECG demonstrates early R wave progression, right axis deviation, right atrial enlargement, ST-segment depressions and T-wave inversions in inferolateral leads – all consistent with right heart strain.
ECG Showing Global Subendocardial Ischemia

Global Subendocardial Ischemia Due to Pulmonary Embolism

There are diffuse ST-segment depressions along with ST-segment elevation in aVR. This patient was discovered to have a saddle pulmonary embolism for which thrombectomy was performed. The ST changes and tachycardia resolved after mechanical retrieval of the embolus.

References