The most common ECG abnormality in PE is nonspecific ST-T wave changes, seen in more than 40 percent of patients. T-wave inversions in the precordial leads mimicking subendocardial infarction may be seen in massive PE. Other ECG changes include new right bundle branch block, p-pulmonale, S1Q3T3 pattern, and clockwise axis rotation.

Sinus tachycardia is the most common rhythm disturbance, although atrial fibrillation or flutter may occur. 7 There is no diagnostic pattern of PE on the ECG. The greatest utility of the ECG is to exclude disorders such as pericarditis or myocardial infarction.

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