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(Chest. 1970;58:205-212.)
© 1970 American College of Chest Physicians

Electrocardiographic Signs of Early Right Ventricular Enlargement in Acute Pulmonary Embolism

McKamy Smith M.D.1 and C. Thorpe Ray M.D.1

1 Department of Internal Medicine, Section on Cardiology, Ochsner Clinic and Ochsner Foundation Hospital, New Orleans, Louisiana

The incidence and duration of right precordial electrocardiographic signs of early right ventricular enlargement were investigated in cases of acute pulmonary embolism. These signs consist of slurring of the ascending limb of the "S" wave in the right precordial leads and regression of the R/S ratio between two successive precordial leads. These changes were observed in 74 of 127 tracings taken at or soon after the onset of symptoms. A correlation was demonstrated between right precordial patterns associated with progressive right ventricular enlargement and the extent of pulmonary arterial occlusion as determined by autopsy or surgery. The electrocardiographic signs under investigation were found to occur more frequently in acute tracings than other patterns associated with acute pulmonary embolism. The presence of right precordial signs of early right ventricular enlargement in acute and serial tracings taken at short intervals provide assistance in the diagnosis, as well as in determining the management of acute pulmonary embolism.




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K. R. Daniel, D. M. Courtney, and J. A. Kline
Assessment of Cardiac Stress From Massive Pulmonary Embolism With 12-Lead ECG
Chest, August 1, 2001; 120(2): 474 - 481.
[Abstract] [Full Text] [PDF]


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