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 – 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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