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66 year old female acute onset shortness of breath

by on August 14, 2011

66 year old female goes to urgent care for evaluation. She stated for 2 days she has been having severe shortness of breath on exertion. She states at rest she has no issues at all, but is unable to walk even a few feet before she is experiences shortness of breath and has to sit down. She denies any pain or any other s/s. Only history is mild hypertension which is managed with medication. Her 02 sats are mid 90’s with Nasal cannula 4 lpm. On exam, her lips and fingernail beds have a bluish tint. She also states that she has been having a runny noise that just started around the same time as her shortness of breath. All v/s are within normal range and lungs are clear = bilat. There has been no recent trauma.

You obtain a 12 lead ekg. What if anything do you see on her 12 lead?
HR 109
PR 140
QRS 102
qt 344
qtc 463

Thank you to everyone who posted on and/or visited this case file. Pulmonary Embolism is the correct diagnosis as seen with the S1Q3T3 pattern on the EKG along with her presenting signs and symptoms. She had bilateral embolisms confirmed by CT scan.

From → Case File, Education

  1. hadikaljouhar permalink

    S1Q3T3 +sinus tach +ant T inversion=> PE

  2. Pretty much what hadikaljouhar said! 🙂

  3. Pulmonary Embolism for the reasons Hadi said.

  4. Troy permalink

    RVH, P-pulmonale, S1Q3T3, pathological Q waves in III and aVF. So RVH strain pattern with old inferior infarct. T-waves in V-leads appear benign. Worst case scenario is a PE. Possibly an underlying chronic/acute lung disease (ARDS, bronchitis, ect)

  5. I copy hadikaljouhar and Troy, also right shift of precordial axis suggesting a concomitant more long term pulmonary pathology.

  6. VinceD permalink

    I agree that it’s prolly an acute PE on chronic lung disease.

  7. Sold on PE. I’m thinking the RAE/RVH/rightward Z-axis is a big fat right atrium and right ventricle due to severe overloading. Maybe chronic changes but I’d put more money on acute. Leads V2/V3 look like they have strange positioning due to the odd change between them.

  8. Anonymous permalink

    S1 QIII and TIII with sinus tachacradia and RBBB or IVCD all these changes suggest PE specially with history , Pulmonary angiography is needed

  9. S1 QIII and TIII with sinus tachacradia and RBBB or IVCD all these changes suggest PE specially with history , Pulmonary angiography is needed

  10. Aaron permalink

    The slurred S waves in lead 1 along with what appear to be Q waves and inverted T waves in lead 3 would cause me to consider a pulmonary embolism.

  11. Capeless Medic permalink

    I think Troy and Christopher hit it on the head.

  12. Anonymous permalink

    acute corpulmonale.. acute exacerbation of chronis copd..

  13. Classic ECG for pulmonary embolism. Clinical scenario perfect for PE, too.

  14. marivic alonzabe permalink

    suggestive of pulmonary embolism

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