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Aid for Prompt Recognition of Pulmonary Embolism

Nathan Frank, MD
JAMA. 1974;227(2):203-204. doi:10.1001/jama.1974.03230150051026.
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To the Editor.—  An extremely useful clinical "pearl" helps in the recognition of pulmonary embolism.Approximately 60% of patients with heart disease who come to necropsy are found to have pulmonary emboli, and only 10% have been recognized antemortem. Embolism is a shocking and usually unexpected cause of death in patients following relatively minor surgery such as herniorrhaphy, hysterectomy, and hip fracture. Early diagnosis and prompt therapy such as anticoagulation can be very effective.The electrocardiogram is a valuable aid in the detection of pulmonary embolism. However, the classic findings originally described by McGinn and White in 1935 will be observed only in approximately 10% of proven cases, if the ECG is recorded shortly after the embolism has occurred. The classical changes that they described were as follows: (1) a deep S1, (2) prominent Q3 and inversion of T3, (3) depression of ST segment in lead II


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