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Patient
57-year-old man hospitalized for severe pulmonary embolism with cardiogenic shock; contraindication to fibrinolysis (previous history of hemorrhagic stroke 3 months earlier); referred to the department for surgical embolectomy;
Trace
Increased heart rate (91 bpm); sinus P-wave of normal size and morphology; couplet of atrial extrasystoles (modification of the pattern of the T-wave); normal PR interval; wide QRS with complete right bundle branch block pattern (QRS duration > 120 ms, rSR' pattern in V1 with delayed intrinsicoid deflection, qRs pattern in V6 with wide and slurred S wave); SIq3 pattern; negative T-waves in V1-V3 and in lead III;
Exergue
The occurrence of a complete right bundle branch block is rare during a pulmonary embolism, represents a sign of severity and is secondary to the sudden increase in right ventricular pressure.
The term acute cor pulmonale refers to the acute manifestations resulting from the strain of lung, pleural or pulmonary circulatory diseases on the right heart. Massive pulmonary embolism is the most common cause of acute cor pulmonale.