A Woman with New Dyspnea. Is the extreme left axis deviation, with negative T-wave in lead III, suggestive of RV strain?

===================================MY Comment by KEN GRAUER, MD (7/26/2020):===================================The ECG in Figure-1 was obtained from a middle-aged woman who presented to the ED with new-onset shortness of breath.QUESTION: Is the inferior lead T wave inversion indicative of RV (Right Ventricular) Strain from acute PE (Pulmonary Embolism)?Figure-1: ECG obtained from a middle-aged woman who presented to the ED with new dyspnea (See text).MY THOUGHTS on ECG #1: As always — I favor a systematic approach to ECG interpretation. Without a systematic approach — it might be all-too-easy to overlook that something is “off” here ...Regardless of whichever systematic approach you favor for 12-lead ECG interpretation — the 1st Step should always be to interpret the rhythm. Once you ’ve ensured that your patient is hemodynamically stable — the, “Watch Your Ps, Qs and 3Rs ” memory aid reminds me of the 5 KEY parameters to assess (CLICK HERE— if interested in more on this Ps, Qs, 3R approach).Although there is no long lead rhythm strip in ECG #1  — the rhythm is regular at a rate of ~80/minute. The QRS complex is narrow.P waves are present — and, these P waves are clearly related to neighboring QRS complexes, because the PR interval is constant. This t...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs