![]() ![]() We entertained the possibility of underlying silent LQTS as a reason for the remarkable QT/QTc prolongation, however the Viskin test-after the resolution of the ECG changes ( Figure 1C)-did not support this hypothesis. Recent studies did not find a direct link between QT prolongation and pulmonary embolism outcome ( 3), however the prolonged QTc group demonstrated significantly increased right ventricular dilatation and systolic dysfunction/stunning ( 3). The exact cause of the prolonged QT and T wave inversion, however, is uncertain and it is also unclear why they only present in select patients. Despite the ECG differences between acquired LQTS and classic global T wave inversion, the pathomechanism behind them is most probably similar and is related to catecholamine surge, as was hypothesized by Walder and Spodick ( 2). However, in our case and in previously published cases on acquired long QT syndrome (LQTS) following PE, there were positive T waves in leads I and aVL ( 1). ECG on the following day showed significant QT/QTc prolongation and extensive T wave inversion ( Figure 1B) similar to what has been described as global T wave inversion. ![]() These are classic signs indicating pulmonary embolism. The ECG on admission ( Figure 1A) shows sinus tachycardia with an S1-Q3-T3 pattern, incomplete right bundle branch block and T wave inversion in V4. The NT-proBNP also decreased to 341 pg/mL. ![]() Repeat echocardiogram prior to leaving the hospital showed improving right ventricular dilation and a slightly lower pulmonary artery systolic pressure of 46 mmHg. The large T-wave inversion and QT prolongation noted in the second ECG gradually resolved in three days ( Figure 1C).Ī Viskin test was performed to exclude silent long QT syndrome, and it was normal. The day after presentation the ECG showed dramatic new changes while there was no significant change in the patient’s clinical condition ( Figure 1B).Ĭoronary angiography showed clear coronary arteries, and his echocardiogram remained unchanged. Since the patient remained hemodynamically stable, he did not meet the criteria for thrombolysis and treatment with low molecular weight heparin was initiated. CT pulmonary angiography showed extensive bilateral lower lobe pulmonary emboli. Doppler ultrasound of the lower extremities revealed a left popliteal vein thrombus. ECG, electrocardiogram.ĭoppler echocardiogram showed a dilated right ventricle and an estimated pulmonary artery systolic pressure of 68 mmHg (normal, <25 mmHg). Interviews with Outstanding Guest Editorsįigure 1 Serial ECG of the patient at presentation (A), next day (B) and three days later (C).Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process. ![]()
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