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Patient
76-year-old woman hospitalized for acute dyspnea 3 days after a transatlantic plane trip; electrocardiogram recorded on arrival at the emergency room;
Trace
Sinus tachycardia (100 bpm); normal PR interval, slightly increased QRS duration (100 ms) with right conduction delay pattern; SIq3T3 pattern (negative T-wave in lead III); absence of Q-wave in the other inferior leads; absence of major repolarization disorders;
A CT-angiography confirmed the diagnosis of non-massive pulmonary embolism; a venous Doppler revealed popliteal venous thrombosis; initiation of treatment by curative dose of LMWH;
Trace
Tracing recorded 2 days after the initial tracing; slowing of the sinus rate (72 bpm); decrease in the size of the S wave in lead I and disappearance of the Q-wave in lead III;
Trace
Tracing recorded 6 months after this episode; normalization of the electrocardiogram with disappearance of the S1Q3 pattern and positive T-wave in lead III;
Exergue
The S1Q3 pattern is not essential for the diagnosis of pulmonary embolism and can be observed in the normal state or in many other diseases. When present, it is observed in the initial phase, only to disappear on subsequent tracings.
In this patient, the electrical signs observed during the pulmonary embolism are modest and rapidly evolving over time (disappearance of the S1Q3 pattern between the first and second tracing).