Article Text

Download PDFPDF
ECG in suspected pulmonary embolism
  1. Duncan Thomson1,
  2. Georgios Kourounis1,
  3. Rebecca Trenear1,
  4. Claudia-Martina Messow2,
  5. Petr Hrobar3,
  6. Alistair Mackay4,
  7. Chris Isles1
  1. 1 Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries, UK
  2. 2 Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
  3. 3 Radiology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
  4. 4 Cardiology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
  1. Correspondence to Professor Chris Isles, Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries DG2 8RX, UK; chris.isles{at}


Objective To establish the diagnostic value of prespecified ECG changes in suspected pulmonary embolism (PE).

Methods Retrospective case–control study in a district general hospital setting. We identified 189 consecutive patients with suspected PE whose CT pulmonary angiogram (CTPA) was positive for a first PE and for whom an ECG taken at the time of presentation was available. We matched these for age±3 years with 189 controls with suspected PE whose CTPA was negative. We considered those with large (n=76) and small (n=113) clot load separately. We scored each ECG for the presence or absence of eight features that have been reported to occur more commonly in PE.

Results 20%–25% of patients with PE, including those with large clot load, had normal ECGs. The most common ECG abnormality in patients with PE was sinus tachycardia (28%). S1Q3T3 (3.7%), P pulmonale (0.5%) and right axis deviation (4.2%) were infrequent findings. Right bundle branch block (9.0%), atrial dysrhythmias (10.1%) and clockwise rotation (20.1%) occurred more frequently but were also common in controls. Right ventricular (RV) strain pattern was significantly more commonly in patients than controls, 11.1% vs 2.6% (sensitivity 11.1%, specificity 97.4%; OR 4.58, 95% CI 1.63 to 15.91; p=0.002), particularly in those with large clot load, 17.1% vs 2.6% (sensitivity 17.1%, specificity 97.4%; OR 7.55, 95% CI 1.62 to 71.58; p=0.005).

Conclusion An ECG showing RV strain in a breathless patient is highly suggestive of PE. Many of the other ECG changes that have been described in PE occur too infrequently to be of predictive value.

  • electrocardiogram
  • right ventricular strain pattern
  • pulmonary embolism

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors CI, DT, GK and RT designed the study. PH and AM were responsible for scoring the CTPAs and ECGs, respectively. CMM undertook the statistical analyses. CI wrote the first draft and worked with DT and GK on the second draft. All authors contributed to the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval In keeping with the policies of the Scottish health boards,

    ethics approval is not required as there were no patient identifiable data.

  • Provenance and peer review Not commissioned; internally peer reviewed.