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Patient
Young woman 24 years of age, followed for lupus and antiphospholipid antibody syndrome, hospitalized for chest pain and dyspnea; electrocardiogram recorded on arrival at the emergency room;
Trace
Sinus tachycardia (132 bpm); normal PR interval, narrow QRS with right conduction delay pattern; S1q3 pattern; flat T-wave in lead III; absence of major repolarization disorders;
An angioscanner confirmed the diagnosis of non-massive pulmonary embolism; initiation of treatment with a curative dose of LMWH;
Trace
Tracing recorded 2 days after the initial tracing; slowing of the sinus rate (103 bpm); decrease in the size of the S wave in lead I and regression of the right conduction delay pattern;
Exergue
The electrocardiogram is not the best diagnostic tool for pulmonary embolism. Indeed, the electrical signs are not very sensitive since only one quarter of the patients (often in the severe forms) present a truly characteristic electrocardiogram. Each abnormality taken individually also has a low specificity, with the distinction between normal and pathological pathways often made on the basis of a comparison with previous or later tracings and searching for a compatible clinical right ventricular overload.
Pulmonary embolism is defined by the abrupt closure, total or partial, of one or more branches of the pulmonary artery, in general by a fibrinocruoric thrombus. This is a frequent, serious, life-threatening condition, yet often undiagnosed because of the polymorphism of clinical signs.