Fatal Acute Cor Pulmonale
Report:
Sinus rhythm 80/min
SVEB
Right axis deviation +130o
Incomplete right bundle branch block
S1Q3T3 (McGinn-White) pattern suggestive of acute cor pulmonale
ST/T changes consistent with ischæmia or cor pulmonale
Comment:
In the context of disseminated carcinoma and sudden collapse, the tracing is virtually diagnostic of massive pulmonary embolism (or equivalent). Tachycardia is not a sine qua non here â some patients are, indeed, bradycardic. The ST segment elevation in 3 and V1 denotes acute RV strain; depression elsewhere may suggest reciprocal changes but is more likely due to associated hypoxæmia and shock.
Her normal baseline ECG, taken a month previously, is shown below. (Fig 26a).
26a. 27. Asymptomatic 73 year old man on verapamil and monopril
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