Dr. Usman's Cardiology Notes

First ECG:   Second ECG: Thought 1: What is your diagnosis based on classic pattern found in this ECG? Thought 2: Does his ECG suggest that he has had a "silent" inferior myocardial infarct? Thought 3: What transient ECG abnormality you found in this case? Explanation: It's not every day you get to see a classic EKG finding for a very common medical condition. Most doctors have heard of S1Q3T3. That's the classic S1Q3T3 pattern that is: Deep S wave in Lead I: ≥1.5 mm Q wave in Lead III: ≥1.5 mm T wave inversion in Lead III This finding is indicative of Right sided heart strain (Acute cor pulmonale) which can often be seen in patients with a pulmonary embolism.  If a young male with shortness of breath and this ECG presents on your boards, the answer is probably pulmonary embolism. Another important finding is "transient Incomplete RBBB" (present in 7 to 60% of cases), this also suggests acute cor pulmonale as electric conduction traverses down t...