Pulmonary and Structural EKG Clues
Key EKG patterns of pulmonary embolism, COPD, and pericardial disease for beginners.
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Questions Covered in This Set
12 cards to master
Most common EKG finding in pulmonary embolism
Sinus tachycardia — nonspecific but present in most PEs; a normal EKG never rules out PE.
What is S1Q3T3?
Deep S wave in lead I, Q wave in lead III, inverted T wave in lead III. Seen in only ~10–20% of PEs; neither sensitive nor specific.
T-wave inversion pattern that strongly suggests PE over anterior ischemia
Anterior TWI in V1–V4 PLUS inferior TWI in III (and aVF) — points to right heart strain.
Other EKG signs of acute right heart strain
New incomplete/complete RBBB, right axis deviation, and new atrial arrhythmias (especially atrial fibrillation).
Define low voltage on EKG
QRS amplitude < 5 mm in all limb leads, or < 10 mm in all precordial leads — seen in COPD (air insulates) and pericardial effusion.
Why does COPD cause poor R-wave progression?
Hyperinflation and diaphragm flattening push the heart into a lower, vertical, rotated position — mimics old anterior MI without infarction.
What is P pulmonale?
Tall, peaked P wave ≥ 2.5 mm in lead II, indicating right atrial enlargement (classic in COPD/cor pulmonale).
Multifocal atrial tachycardia (MAT) criteria and how to distinguish from AF
Irregularly irregular rate > 100 bpm with ≥ 3 distinct P-wave morphologies. MAT has visible varied P waves before each QRS; AF has none. Nearly pathognomonic for decompensated COPD.
Hallmark ST pattern of acute pericarditis
Widespread concave-upward ('saddleback') ST elevation in I, II, aVL, aVF, V2–V6, with reciprocal depression only in aVR and V1.
Most specific EKG sign of pericarditis
PR-segment depression in the limb leads with PR elevation in aVR (atrial injury current).
V6 ratio favoring pericarditis over STEMI
ST-elevation-to-T-wave-height ratio in V6 > 0.25, with no inferior ST depression accompanying anterior elevation.
Spodick stages of pericarditis
1) Diffuse STE with PR depression → 2) normalization → 3) diffuse T-wave inversion → 4) resolution; evolves over days versus hours for STEMI.
