A man in his 50s with shortness of breath

Sent by Tom Fiero, written by Pendell Meyers A man in his 50s presented with acute shortness of breath. Unfortunately we do not have access to the patients presenting vital signs.Here is his ECG:Original image, suboptimal qualityQuality improved with PM Cardio digitizationThe ECG is highly suggestive of acute right heart strain, with sinus tachycardia, S1Q3T3, and T wave inversions in anterior and inferior with morphology consistent with acute right heart strain. There is also STE in lead III with reciprocal depression in aVL and I, as well as some subendocardial ischemia pattern with STD in V5-V6 and STE in aVR. Thus, the ECG could be considered similar to Aslanger ' s pattern (inferior OMI plus SEI pattern). We have seen this pattern in many pts with acute right heart strain on this blog._________________ Smith: The combination of T-wave inversion in V1-V3 and in lead III is very specific for acute pulmonary embolism.  Aslanger ' s is a combination of acute inferior OMI plus subendocardial ischemia, anddue to the ischemia vectors, it has STE only in lead III.  It usually presents with anupright T-wave in both precordial leads and in lead III.  The ECG in this case has aninverted T-wave in both precordial leads and lead III.  Moreover, what I call " domed " T-wave inversion in V1-V3 is typical for acute PE and NOT typical of ACS (i.e., Wellens ' ), presumably because the source of the T-wave inversion is RV strain, not LV ischemia.&nbs...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs