ECG and Radiological Data of Pulmonary Embolism (PE)

ECG and Radiological Data of Pulmonary Embolism (PE)

ECG Findings

ECG in pulmonary embolism shows non-specific signs of right heart overload. These include the SI, QIII, TIII pattern, characterized by:

  • A deep S wave in the first standard lead.
  • A deep Q wave and T wave inversion in the third lead.
  • An increase in the R wave amplitude in the third lead.
  • A leftward shift of the transition zone (seen in V4-V6).
  • Splitting of the QRS complex in V1-V2.
  • Signs of right bundle branch block (RBBB), though this may be absent.

Radiological Data

Radiological signs of PE include:

  • Deformation of the lung root and absence of vascular markings on the affected side.
  • Consolidation areas in the lungs with pleural reaction.
    It is important to note that radiological findings often lag behind clinical presentations. High-quality imaging requires using a stationary radiological machine with breath-hold techniques. Portable machines generally do not produce high-quality images, and thus, the decision for a radiological examination should be carefully considered for critically ill patients.

Principles of Intensive Therapy for PE

Based on pathogenesis, intensive therapy for PE should be approached in three directions:

  1. Sustaining life in the first few minutes.
  2. Eliminating pathological reflex responses.
  3. Thrombus removal.

1. Sustaining Life

This involves a set of resuscitation measures to support the patient’s vital functions.

2. Eliminating Pathological Reflex Responses

This includes managing fear and pain through:

  • Neuroleptanalgesia (NLA) to reduce fear and pain, hypercatecholaminemia, and improve blood rheological properties.
  • Heparin, used not only as an anticoagulant but also as an antiserotonin agent.
  • Drugs to relieve arteriolo- and bronchiolospasm, such as xanthine derivatives, atropine, and prednisolone or its analogs.

3. Thrombus Removal

Thrombus removal can be done conservatively or surgically. However, surgery has not gained wide acceptance due to significant technical challenges and high postoperative mortality rates.

Emergency Care

After resuscitation (if necessary), conservative pathogenetic treatment is carried out, focusing on two main areas:

  1. Thrombolytic therapy.
  2. Preventing further thrombus formation.

By addressing these critical areas, the immediate and ongoing management of pulmonary embolism can be effectively implemented to improve patient outcomes.