ECG manifestations in submassive and massive pulmonary embolism. Report of 4 cases and review of literature.

ECG findings suggestive of right ventricular (RV) hemodynamic derangement, in the appropriate clinical setting, can lead to further diagnostic consideration and earlier institution of treatment, aiming to decrease the high morbidity and mortality associated with submassive and massive pulmonary embolism (PE). In this paper, we review 4 cases with chest computed tomography (CT) confirmed PE with their respective ECG findings. In all the cases patients had an RV strain pattern on ECG, although in different clinical scenarios, including one with an initial diagnosis of acute coronary syndrome (ACS). In one case, a transitory short PR interval was seen, a finding not previously reported, in the literature. The most common finding was T wave inversion (Twi) in the anterior leads.