According to the paramedics, the response time was of 15 minutes, in which the patient’s wife was oriented to perform cardiopulmonary resuscitation (CPR). Male of 47 years old with no history of known comorbidities was taken to the emergency department by ambulance in a cardiac arrest. It is classically related to pulmonary embolism (PE), but not pathognomonic of it. It has the following voltage criteria: S wave in lead I and Q wave in lead III, and amplitude of more than 0.15 mV (1.5 mm) associated with inversion of the T wave in lead III. The S1Q3T3 sign, also known as the McGinn-White sign was described in 1935 by McGinn and White. It may give some clues to the etiology of the SCA. The electrocardiogram (ECG) should be readily performed during the etiological investigation because It is a noninvasive, low cost and also widely available in areas with scarcity of resources. These events are more common in patients with structural heart disease, particularly coronary heart disease. Sudden cardiac arrest (SCA) is the sudden hemodynamic collapse, typically due to malignant arrhythmias. He presented good clinical evolution and was discharged from the hospital with outpatient return. Therefore, it was decided to undergo myocardial revascularization surgery. Subsequently the patient underwent cardiac catheterization that showed: anterior descending artery with proximal obstruction of 90%, first and second diagonal branch with proximal obstruction of 80%, left circumflex artery with proximal obstruction of 90% and a dominant right coronary artery occluded in the middle third of the artery. Laboratory tests revealed a troponin I rise from 1,25 ug/L to 31,02 ug/L. The electrocardiogram showed sinus rhythm with a s1q3t3 pattern. The return of spontaneous circulation occurred in aroud 50 minutes (after 35 minutes of cardiopulmonary resuscitation. In our case, a 47 years old man with no history of known comorbities was taken to the emergency department by ambulance in a cardiac arrest. All rights reserved.The S1Q3T3 sign, also known as the McGinn-White is classically associated with pulmonary embolism, but not is not a pathognomonic sign. Approximately one-quarter of patients will have a new sinus tachycardia, and approximately one-quarter will have no change in their ECG.ĮCG changes with pulmonary embolism electrocardiographic changes electrocardiographic changes with pulmonary embolism pulmonary embolism.Ĭopyright © 2016 Elsevier Inc. The most common ECG changes when compared with previous ECG in the setting of PE are T wave inversion and flattening, most commonly in the inferior leads, and occurring in approximately one-third of cases. In 24.1% of patients, no new ECG changes were noted, with this finding more likely to occur in patients younger than 60 years. A new sinus tachycardia occurred in 27.3% of cases. New T wave flattening, also most commonly in the inferior leads, was the second most common change, occurring in 29.5%. New T wave inversions, commonly in the inferior leads, were the most common change found, occurring in 34.4% of cases. Each patient's presenting ECG was compared with their most recent ECG obtained before diagnosis of PE.Ī total of 352 cases were reviewed. Our aim was to identify the most common ECG changes in patients with known PE when their ECGs were compared with their previous ECGs.Ī retrospective chart review of patients diagnosed with PE in the emergency department was performed. Previous studies have evaluated ECG patterns predictive of pulmonary embolism (PE) at the time of PE diagnosis, though none have examined ECG changes in these patients when compared with their previous ECGs. The electronic medical record is a relatively new technology that allows quick review of patients' previous medical records, including previous electrocardiograms (ECGs).