Acute Cor Pulmonale
Report:
Sinus tachycardia 100/min
VEB
S1Q3T3 (McGinn-White) pattern
QRV1
Consistent with acute cor pulmonale
Comment:
This is a classical picture of acute pulmonary embolism, but things are not always what they seem! The patient had advanced chronic COAD and presented with bi-basal pneumonia and gross respiratory (and ventilatory) failure and shock. She died the same day. Autopsy showed pneumonia in both lower lobes and œdema of both upper lobes, with normal left-sided chambers as predicted by her echocardiogram. The upper lobe œdema may have been due to ARDS or terminal LV failure. There were no emboli.
Anteroseptal infarction may be suggested by QR with ST elevation in V1, but the Q waves usually remain confined to V1 in acute cor pulmonale. Sometimes the differential diagnosis is difficult.
Similarly, chronic cor pulmonale, which this patient had, can have all the ECG findings of its acute counterpart81. In addition, pulmonary embolism and other catastrophes may complicate chronic cor pulmonale. As always, the clinical picture is the best tool for the differential diagnosis.
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