Correlation between ST-segment elevation and negative T waves in the precordial leads in acute pulmonary embolism: insights into serial electrocardiogram changes.
Ann Noninvasive Electrocardiol. 2014 Jul;19(4):398-405
Authors: Zhong-Qun Z, Bo Y, Nikus KC, Pérez-Riera AR, Chong-Quan W, Xian-Ming W
BACKGROUND: Acute pulmonary embolism (APE) is often misdiagnosed as acute coronary syndrome because of the similarity of the presenting symptoms and of the electrocardiogram (ECG) manifestations. In APE, ST-segment elevation (STE) in leads V1 to V3 /V4 , mimicking anteroseptal myocardial infarction, is not a rare phenomenon. Negative T waves (NTW) in the precordial leads mimicking the "Wellens' syndrome" is an important ECG manifestation of APE. The evolution of these ECG changes-STE and NTW-in APE has not been thoroughly studied.
METHODS: We present two patient cases with APE and their evolving serial ECGs to analyze the correlation between STE and NTW.
RESULTS: NTW developed later than STE in these two patient cases.
CONCLUSIONS: NTW might represent a "postischemic" ECG pattern indicating a previous stage with transmural myocardial ischemia.
PMID: 24206526 [PubMed - indexed for MEDLINE]