After a successful Total Hip Replacement a 59 year old patient developed severe chest pain. Echocardiography revealed reduced wall motion of right ventricle with slow flow across the tricuspid valve. Which of the following is most likely diagnosis?
The primary use of the ECG is to rule out other causes of chest pain. An electrocardiogram (ECG) is routinely done on people with chest pain to quickly diagnose myocardial infarctions (hea attacks), an impoant differential diagnosis in an individual with chest pain. While ceain ECG changes may occur with PE, none are specific enough to confirm or sensitive enough to rule out the diagnosis. An ECG may show signs of right hea strain or acute cor pulmonale in cases of large PEs -- the classic signs are a large S wave in lead I, a large Q wave in lead III, and an inveed T wave in lead III (S1Q3T3), which occurs in 12-50% of people with the diagnosis, yet also occurs in 12% without the diagnosis. This is occasionally present (occurring in up to 20% of people), but may also occur in other acute lung conditions, and, therefore, has limited diagnostic value. The most commonly seen signs in the ECG are sinus tachycardia, right axis detion, and right bundle branch block.Sinus tachycardia, however, is still only found in 8-69% of people with PE. ECG findings associated with pulmonary emboli may suggest worse prognosis since the six findings identified with RV strain on ECG (hea rate > 100 beats per minute, S1Q3T3, inveed T waves in leads V1-V4, ST elevation in aVR, complete right bundle branch block, and atrial fibrillation) are associated with increased risk of circulatory shock and death. Cases with inveed T in leads V1-3 are suspected with PE or inferior myocardial infarction. PE cases show inveed T waves in leads II and aVF, but inferior myocardial infarction cases do not show inveed T waves in II and aVF. Ref Harrison 20th ed pg 1443
Pulmonary embolism
Aoic dissection
Dilated cardiomyopathy
Right ventricular infarction
C.V.S