S1Q3T3 pattern leading to early diagnosis of pulmonary embolism.
S1Q3T3 pattern leading to early diagnosis of pulmonary embolism.
复制标题
DOI：
10.1136/bcr-2012-006569
复制
发表时间：
2012-07-09
期刊：
影响因子：
0.9
通讯作者：
Shahani, Lokesh
中科院分区：
文献类型：
--
作者：
Shahani, Lokesh
然而，急性肺栓塞(PE)很常见，是一种致命的疾病，需要及早诊断和治疗以防止死亡。然而，多种多样的临床表现使诊断变得困难。作者报告一位56岁截瘫男子，表现为急性呼吸困难和胸部不适。患者最近停止使用抗凝剂来预防静脉血栓栓塞症。心电图显示窦性心动过速并伴有I导联的S波、III导联的Q波和倒置T波，与急性大面积PE引起肺心病有关(图1)。1虽然不敏感，但这引起了PE的怀疑，考虑到临床表现，要求进行CT肺血管造影，显示双侧主肺动脉广泛的血栓栓塞性疾病，延伸至肺叶和节段肺动脉。超声心动图显示右室和心房明显增大，并伴有右室功能障碍和劳损。考虑到临床表现，该患者是纤溶治疗的候选对象，并有良好的结果。Petruzzeli研究了疑似PE患者的心电图异常，发现PR移位；aVR晚R，V1或V2 S模糊，V1或V2明显更常见S1Q3T3模式和T波倒置。2进一步研究发现，在确诊为PE的患者中，Nazeyllas等人仅发现I波的S波和III的Q波明显更常见。认识到这些心电图结果可能会促使临床医生考虑PE并导致早期诊断。
Acute pulmonary embolism (PE) is common, however, being a fatal disease prompting early diagnosis and treatment to prevent mortality. However, the varying clinical picture makes diagnosis difficult. The author reports a 56-year-old paraplegic man who presented with acute dyspnoea and discomfort in the chest. The patient had recently discontinued his anticoagulant use for prevention of venous thromboembolic disease. The ECG showed the finding of sinus tachycardia along with S wave in lead I, Q wave and inverted T wave in lead III which has been associated with acute massive PE causing cor pulmonale (figure 1). 1 Though not sensitive, this raised the suspicion PE and considering the clinical picture a CT pulmonary angiography was ordered that showed extensive thromboembolic disease in the bilateral main pulmonary arteries extending to the lobar and segmental pulmonary arteries. An echocardiogram demonstrated significant right ventricular and atrial enlargement with right ventricular dysfunction and strain pattern. Considering the clinical picture the patient was a candidate for fibrinolytic therapy and had a favourable outcome. Petruzzeli studied ECG abnormalities in patients with suspected PE and found PR displacement; late R in avR, slurred S in V1 or V2, the S1Q3T3 pattern and T wave inversion in V1 or V2 were significantly more common in patients with confirmed PE. 2 Further, Nazeyrollas et al3 found only an S wave in I and Q wave in III significantly more common among those with confirmed PE. Recognising these ECG findings could prompt clinicians to consider PE and lead to earlier diagnosis of the same.