Serial changes in negative T wave on electrocardiogram in acute pulmonary thromboembolism

• Published in: International journal of cardiology 1999-12, Vol.72 (1), p.65-72
• Main Authors: Yoshinaga, Takayuki, Ikeda, Satoshi, Nishimura, Eri, Shioguchi, Kosuke, Shikuwa, Masahiro, Miyahara, Yoshiyuki, Kohno, Shigeru
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Echocardiography; Electrocardiogram; Electrocardiography; Female; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Negative T wave; Pneumology; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - drug therapy; Pulmonary Embolism - physiopathology; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Pulmonary thromboembolism; Pulmonary Wedge Pressure; Thrombolytic Therapy
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/S0167-5273(99)00159-X

A negative T wave is frequently observed in precordial ECG leads in patients with acute pulmonary thromboembolism. We investigated the clinical significance of negative T wave in 15 patients with acute pulmonary thromboembolism who were treated with thrombolytic agents by measuring the mean pulmonary artery pressure and ratio of right to left ventricular end-diastolic diameter using echocardiography and ECG. The study included only patients with massive acute pulmonary thromboembolism of a mean age of 65±9.7 years (±SD). A negative T wave was observed on admission in 10 patients but was later detected in 14 of the 15 patients. The mean amplitude of the negative T wave increased within 1 week then decreased after thrombolytic treatment. The peak negative amplitude of the T wave was observed from 1 to 7 days (mean, 2.6±1.8 days) and disappeared afterwards. During this period, improvements in both the mean pulmonary artery pressure (37.8±11.2 to 19.1±6.7 mmHg) and the ratio of right to left ventricular end-diastolic diameter (0.97±0.16 to 0.51±0.13) were noted in all patients. Our results suggest that an increase in the amplitude of negative T wave in precordial leads after thrombolytic therapy in patients with massive acute pulmonary thromboembolism reflects improvement in cardiopulmonary hemodynamics.